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Part‐time Position Available

The Historical Commission seeks to fill a position at the Freedom Rides Museum located in the historic Greyhound Bus Station in Montgomery, AL. In , an integrated group of 21 young college students – known as the – met mob violence with non‐violence and courage at the Montgomery Bus Station. Their actions helped end in all interstate transportation.

Duties of this position include staffing museum during regular open hours and as needed for groups with reservations; conducting guided tours, scheduling group tours, responding to tour requests via phone and email, coordinating dates for tours and maintaining the tour calendar; completing cash register and credit card transactions; submitting basic reports on daily transactions, weekly and quarterly visitation numbers and retail sales; reconciling cash register record with receipts; opening and closing the site daily including light cleaning, inspecting exhibits and condition of art and artifacts, checking lighting, and changing bulbs when needed; notifying site director of museum inventory and building issues; performing office and computer work including preparing daily and weekly numbers.

Other duties include historical and education program research; helping to develop education programs and special events; some social media posts and other daily tasks as assigned.

This is a part‐time position ranging from 30‐35 hours per week. Candidate must be available to work Monday – Saturday from 11:00 am – 4:30 pm. Basic knowledge in Microsoft Word and Excel and experience with a printer/scanner and email preferred.

About the Alabama Historical Commission Located in historic downtown Montgomery at 468 S. Perry Street, the Alabama Historical Commission is the state historic preservation agency for Alabama. The agency was created by an act of the state legislature in 1966 with a mission to protect, preserve and interpret Alabama’s historic places. AHC works to accomplish its mission through two fields of endeavor: Preservation and promotion of state-owned historic sites as public attractions; and, statewide programs to assist people, groups, towns, and cities with local preservation activities. For a complete list of programs and properties owned and operated by the AHC, hours of operation, and admission fees please visit ahc.alabama.gov.

Please complete the application and return to:

Dorothy Walker, Site Director Freedom Rides Museum Alabama Historical Commission 468 South Perry Street Montgomery, AL 36104 Office phone: 334/230‐2676 Museum phone: 334/414‐8647 [email protected] [email protected] Form 3 – Revised August 2015 ENTER ALL NINE DIGITS OFS SOCIALOCIAL S SECURITYECURITY N NUMBERUMBER: : ______- ______- ______DO NOT WRITE IN THIS SPACE A P P L I C A T I O N F O R E X A M I N A T I O N General Instructions RETURN TO: STATE OF ALABAMA A SEPARATE APPLICATION COMPLETE THIS SECTION IF YOU ARE CLAIMING VETERAN’S PREFERENCE PERSONNEL DEPARTMENT IS REQUIRED FOR EACH If you claim Veteran’s Preference, check the type below. Attach copies (which will not be returned) of the required documents to your application to support your claim. 64 NORTH UNION STREET JOB. Do not write in shaded 1 ( ) Veteran (5 points) - Requires DD214 or document showing dates of service and type of discharge. If this has been submitted previously and is on file with this P. O. BOX 304100 areas. Complete all parts of office, you may disregard this requirement. Note: Must be active duty for other than training purposes. MONTGOMERY, ALABAMA 36130-4100 the application. Applications not prop- erly completed will be returned. Photo- 2 ( ) Disabled Veteran (10 points) - Requires DD214 or other document as above and letter of disability from V.A. dated within last 6 months. V.A. letter must be kept WWW.PERSONNEL.ALABAMA.GOV copied and facsimile applications will updated until register is established or you lose the extra 5 points. FAX: (334) 242-1110 be accepted. 3 ( ) Deceased Veteran’s spouse (10 points) - Requires DD214 or other document as above and marriage and death certificates. Cannot be claimed if spouse remarries. 4 ( ) Disabled Veteran’s spouse (10 points) - Requires DD214 or other document as above and V.A. letter of disability dated within last 6 months. Cannot be claimed ENTER LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER BELOW unless still married to disabled veteran who because of this disability is not them self qualified. 5 ( ) Permanently Disabled Veteran (10 points) - Requires DD214 or other document as above indicating veteran is permanently disabled or DD214 or other document and V.A. letter indicating permanent disability. Print All Information Legibly Job Title of Examination (one per application): Option (if applicable):

COMPLETE THIS SECTION IN ORDER TO BE SCHEDULED FOR WRITTEN EXAMS WrittenWritten exams will be given in the places below for which a sufficient numbernumber ofof applicantsapplicants expressexpress preference.preference. IndicateIndicate byby numbernumber youryour 1st,1st, 2nd 2nd and and 3rd 3rd choices. choices. 31 ( ) Birmingham Alexander City 6 4 (( )) Jacksonville Decatur 96 (( )) Montgomery Jacksonville 11 8 ( ( ) ) Florence Mobile 13 10 ( ( ) ) Huntsville Selma 12 ( ) Tuscaloosa Full Name______53 ( ) Dothan Birmingham 8 5 (( )) Mobile Dothan 107 (( )) Selma Linden 12 9 ( ( ) ) Tuscaloosa Montgomery 1411 ( ( ) ) TroyFlorence 13 ( ) Huntsville First Middle Last IfIf youyou qualify,qualify, you you will will receive receive a anotice notice showing showing the the place place and and time time you you are areto report to report for thefor exam.the exam. Mailing Address ______House or Apartment Number Street WhereWhere did you learn of this job? (check all that apply) ______City State County Zip Code E-mail Address 1 ( ) State EmploymentCareer Center Service 5 ( ) Friend/Relative 9 ( ) Legislative Representative 13 ( ) TV/Radio Commercial 2 ( ) Job Announcement Notice 6 ( ) Dept. News Bulletin 10 ( ) State Recruiter / Counselor 14 ( ) State Personnel Dept. WebsiteWebsite Telephone Number: Home (____)______Cell (____)______Work (____)______3 ( ) Newspaper 7 ( ) Rehabilitation Services 1111 ( ) State Personnel Dept. Information Board 15 ( ) Other WebsiteWebsite Area Code Area Code Area Code 4 ( ) College Placement/Career OfficeOffice 8 ( ) High School Counselor 12 ( ) Outreach Program (i.e. Church) 16 ( ) Other ______The following information is required for governmental reporting or record keeping purposes: AVAILABILITYAVAILABILITY Date of Birth ______Sex (check one) 1. ( ) Male 2. ( ) Female 81 - Northwest Alabama 84 - Jasper/ 87 - East Central Alabama 90 - Montgomery Area 93 - South Central (Month) (Day) (Year) 17 Colbert WinfieldWinfield Area 08 Calhoun 01 Autauga Alabama 30 Franklin 29 Fayette 09 Chambers 26 Elmore 07 Butler 30 Franklin 29 Fayette 09 Chambers 26 Elmore 07 Butler Race (check one) 1. ( ) White 2. ( ) Black 3. ( ) Hispanic 4. ( ) Asian or Pacific Islander 5. ( ) American Indian or Alaskan Native 6. ( ) Other 39 Lauderdale 38 Lamar 14 Clay 81 82 43 Lowndes 18 Conecuh 40 Lawrence 47 Marion 15 Cleburne 51 Montgomery 20 Covington 40 Lawrence 47 Marion 15 Cleburne 83 51 Montgomery 20 Covington 64 WalkerWalker 19 Coosa 21 Crenshaw 67 Winston 56 Randolph 27 Escambia EDUCATION: CIRCLE OR BRACKET THE HIGHEST GRADE OF SCHOOL COMPLETED. ED 67 Winston 56 Randolph 84 27 Escambia 61 TalladegaTalladega 50 Monroe High School Diploma or GED? ( ) Yes ( ) No 1 2 3 4 5 6 7 8 9 10 11 12 College 1 2 3 4 LC 62 TallapoosaTallapoosa 86 82 - Huntsville/ 85 - TuscaloosaTuscaloosa Area 88 - Southwest Alabama 87 91 - Phenix City 94 - Dothan Area PROVIDE INFORMATION ON ALL SCHOOLS ATTENDED. SPECIFY UNDERGRADUATE OR GRADUATE WORK. IF ONLINE, INDICATE BY *ASTERISK. Decatur Area 04 Bibb 12 Choctaw 85 TroyTroy Area 16 CoffeeCoffee Dates of Attendance Credit Hours Did You 36 Jackson 32 Greene 13 Clarke 03 Barbour 23 Dale Month/Year Earned Graduate? Type of Degree 42 Limestone 33 Hale 46 Marengo 06 Bullock 31 Geneva Name and Location of School From To Sem. Qtr. Yes No and Date Major 45 Madison 54 Pickens 65 Washington 41 Lee 34 Henry 45 Madison 54 Pickens 65 Washington 89 90 41 Lee 34 Henry ______48 Marshall 60 Sumter 44 Macon 35 48 Marshall 60 Sumter 91 44 Macon 35 Houston 52 MorganMorgan 63 TuscaloosaTuscaloosa 55 Pike ______88 57 Russell ______83 - Northeast Alabama 86 - Birmingham Area 89 - Selma/Clanton Area 93 92 - Mobile Area 95 - Statewide 10 Cherokee 05 Blount 1111 Chilton 94 02 Baldwin ( YouYou will be PROFESSIONAL LICENSE OR CERTIFICATE 25 Dekalb 22 Cullman 24 Dallas 49 Mobile considered for License/Certificate Issued By Field/Trade/Specialization License/Certificate No. Issue Date Expiration Date 28 Etowah 37 JeffersonJefferson 53 Perry 92 vacancies through-through- 58 Shelby 66 WilcoxWilcox out the state. ______59 St. Clair Relocation may 59 St. Clair Relocation may ______be necessary) LIST COURSES SUCCESSFULLY COMPLETED (AND HOURS EARNED) WHICH ARE PARTICULARLY RELATED TO POSITION (attach additional sheets, if needed) Please answer the following questions with care. List in the spaces provided those areas of the state in which you would accept employment. YouYou will be ______considered for employment only in the locations you indicate. YouYou may choose a combination of up to seven counties and/or regions from the list above. If you list a region, you will be considered available for all counties in that region. The counties in each region are listed alphabetically below the region. ______YouYou will not be considered for jobs involving overnight travel or shift workwork unless you so indicate. CERTIFICATION STATEMENT List the numbers of up to 7 counties and/or regions where you are willing to work ______I hereby certify, under penalty of perjury, that all statements on or attached to this application are true, correct, and complete. I further If you want to be considered for appointment by only certain state agencies, indicate here ______agree and understand that any false or deceptive information herein, regardless of time of discovery, may cause forfeiture on my part of any Enter the earliest date you will be available to interview for employment. (Your name will not appear on a list of eligibles until this date.) ______employment in the service of the State of Alabama and may prohibit me from being considered for future employment. I understand that all Month Day YearYear information on this application is subject to verification, and I consent to criminal history background, military service, and employment WillWill you accept work involving overnight travel? ( ) YesYes ( ) No WillWill you accept part-time work? ( ) YesYes ( ) No checks. I agree to allow my employer/prospective employer to receive a copy of my Alabama Background Check report through ALEA. WillWill you accept temporary work? ( ) YesYes ( ) No Will you accept conditional work? ( ) Yes ( ) No If employed, I agree to electronic deposits of my payroll check and other state payments; and consistent with applicable laws, to receive compensatory time off in lieu of overtime compensation for any overtime hours worked. The State Personnel Department is not responsible WhichWhich shiftsshifts areare youyou willingwilling toto work?work? 0.0. ( ) allall shiftsshifts 1. ( )) 1st onlyonly 2. ( )) 2nd2nd onlyonly 3.3. (( )) 3rd3rd onlyonly 4.4. (( )) 1st andand 2nd2nd onlyonly 5.5. (( )) 1st1st andand 3rd3rd onlyonly 6.6. ( ) 2nd and 3rd3rd onlyonly for late receipt of applications due to mail service or faxing malfunctions.

Signature______Date______NOTE: YourYour name will be placed on inactive status forfor this class afterafter declining threethree offers of employment consideration oror failing to replyreply to an agency’sagency’s inquiry concerning youryour availability.availability. YourYour name may be restoredrestored to the active registerregister by written request.request. Your name may be removed from an employment register for any disqualifying reason. AN EQUAL OPPORTUNITY EMPLOYER LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER: ______LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER: ______List three independent persons, not relatives or present employer, who know you well enough to give information about you. 2. Employer Your Official Job Title

NAME ADDRESS AND PHONE NUMBER EMPLOYER Address Type of Business

FROM TO Total Number of Hours Beginning Salary Ending Salary Month Year Month Year Months Worked Per Week ______$______Per ______$______Per ______Number/Title of Employees You Supervised Equipment You Operated On a Continuing Basis Name, Title and Telephone Number Reason for Leaving of Supervisor Describe Your Duties in Detail

Should you need testing accommodations due to a health problem or disability, you must contact the State Personnel Department. Have you ever been involuntarily terminated, discharged, forced to resign, resigned with disciplinary action pending, or resigned in lieu of termination from any job? ( ) Yes ( ) No If you answered Yes to the above question, provide an explanation noting any mitigating or extenuating circumstances in the space below. If necessary, you may use a separate sheet or sheets and attach to the application.

Have you ever been convicted of a misdemeanor or felony crime? (including pleading guilty or nolo contendere.) ( ) Yes ( ) No If you answered Yes to the above question, list in the space below all prior misdemeanor and felony convictions and any extenuating or mitigating circumstances regarding 3. Employer Your Official Job Title such convictions. If necessary, you may use a separate sheet or sheets and attach to application. Address Type of Business

FROM TO Total Number of Hours Beginning Salary Ending Salary Month Year Month Year Months Worked Per Week Have you ever been known by any other name(s)? ( ) Yes ( ) No If Yes, what name(s)? ______$______Per ______$______Per ______Number/Title of Employees You Supervised Equipment You Operated On a Continuing Basis Name, Title and Telephone Number Reason for Leaving Note: A criminal conviction will not necessarily be a bar to consideration for employment, except that a felony of Supervisor conviction will bar employment in a law enforcement job. The disclosure of a misdemeanor conviction will not Describe Your Duties in Detail automatically result in disqualification. Criminal histories will be submitted to the National Crime Information Center (NCIC) for verification. Failure to disclose a conviction may be considered as grounds for disqualification. For these reasons, applicants should be careful to disclose all criminal convictions.

WORK HISTORY THIS SECTION MUST BE COMPLETED REGARDLESS OF WHETHER OR NOT A RÉSUMÉ IS ATTACHED.

Begin with your PRESENT or most recent employment. List in REVERSE ORDER periods of employment. Each time you changed jobs or your title changed should be listed as a separate period. Describe in detail your duties. (Attach additional sheets if needed.)

4. Employer Your Official Job Title 1. Current or Last Employer Your Official Job Title Address Type of Business Address Type of Business FROM TO Total Number of Hours Beginning Salary Ending Salary FROM TO Total Number of Hours Beginning Salary Ending Salary Month Year Month Year Months Worked Per Week Month Year Month Year Months Worked Per Week ______$______Per ______$______Per ______$______Per ______$______Per ______Number/Title of Employees You Supervised Equipment You Operated Number/Title of Employees You Supervised Equipment You Operated On a Continuing Basis On a Continuing Basis Name, Title and Telephone Number Reason for Leaving Name, Title and Telephone Number Reason for Leaving of Supervisor of Supervisor Describe Your Duties in Detail Describe Your Duties in Detail

5. USING THE ABOVE FORMAT, SHOW OTHER EXPERIENCE BY USING ADDITIONAL SHEETS. LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER: ______LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER: ______List three independent persons, not relatives or present employer, who know you well enough to give information about you. 2. Employer Your Official Job Title

NAME ADDRESS AND PHONE NUMBER EMPLOYER Address Type of Business

FROM TO Total Number of Hours Beginning Salary Ending Salary Month Year Month Year Months Worked Per Week ______$______Per ______$______Per ______Number/Title of Employees You Supervised Equipment You Operated On a Continuing Basis Name, Title and Telephone Number Reason for Leaving of Supervisor Describe Your Duties in Detail

Should you need testing accommodations due to a health problem or disability, you must contact the State Personnel Department. Have you ever been involuntarily terminated, discharged, forced to resign, resigned with disciplinary action pending, or resigned in lieu of termination from any job? ( ) Yes ( ) No If you answered Yes to the above question, provide an explanation noting any mitigating or extenuating circumstances in the space below. If necessary, you may use a separate sheet or sheets and attach to the application.

Have you ever been convicted of a misdemeanor or felony crime? (including pleading guilty or nolo contendere.) ( ) Yes ( ) No If you answered Yes to the above question, list in the space below all prior misdemeanor and felony convictions and any extenuating or mitigating circumstances regarding 3. Employer Your Official Job Title such convictions. If necessary, you may use a separate sheet or sheets and attach to application. Address Type of Business

FROM TO Total Number of Hours Beginning Salary Ending Salary Month Year Month Year Months Worked Per Week Have you ever been known by any other name(s)? ( ) Yes ( ) No If Yes, what name(s)? ______$______Per ______$______Per ______Number/Title of Employees You Supervised Equipment You Operated On a Continuing Basis Name, Title and Telephone Number Reason for Leaving Note: A criminal conviction will not necessarily be a bar to consideration for employment, except that a felony of Supervisor conviction will bar employment in a law enforcement job. The disclosure of a misdemeanor conviction will not Describe Your Duties in Detail automatically result in disqualification. Criminal histories will be submitted to the National Crime Information Center (NCIC) for verification. Failure to disclose a conviction may be considered as grounds for disqualification. For these reasons, applicants should be careful to disclose all criminal convictions.

WORK HISTORY THIS SECTION MUST BE COMPLETED REGARDLESS OF WHETHER OR NOT A RÉSUMÉ IS ATTACHED.

Begin with your PRESENT or most recent employment. List in REVERSE ORDER periods of employment. Each time you changed jobs or your title changed should be listed as a separate period. Describe in detail your duties. (Attach additional sheets if needed.)

4. Employer Your Official Job Title 1. Current or Last Employer Your Official Job Title Address Type of Business Address Type of Business FROM TO Total Number of Hours Beginning Salary Ending Salary FROM TO Total Number of Hours Beginning Salary Ending Salary Month Year Month Year Months Worked Per Week Month Year Month Year Months Worked Per Week ______$______Per ______$______Per ______$______Per ______$______Per ______Number/Title of Employees You Supervised Equipment You Operated Number/Title of Employees You Supervised Equipment You Operated On a Continuing Basis On a Continuing Basis Name, Title and Telephone Number Reason for Leaving Name, Title and Telephone Number Reason for Leaving of Supervisor of Supervisor Describe Your Duties in Detail Describe Your Duties in Detail

5. USING THE ABOVE FORMAT, SHOW OTHER EXPERIENCE BY USING ADDITIONAL SHEETS. Form 3 – Revised August 2015 ENTER ALL NINE DIGITS OFS SOCIALOCIAL S SECURITYECURITY N NUMBERUMBER: : ______- ______- ______DO NOT WRITE IN THIS SPACE A P P L I C A T I O N F O R E X A M I N A T I O N General Instructions RETURN TO: STATE OF ALABAMA A SEPARATE APPLICATION COMPLETE THIS SECTION IF YOU ARE CLAIMING VETERAN’S PREFERENCE PERSONNEL DEPARTMENT IS REQUIRED FOR EACH If you claim Veteran’s Preference, check the type below. Attach copies (which will not be returned) of the required documents to your application to support your claim. 64 NORTH UNION STREET JOB. Do not write in shaded 1 ( ) Veteran (5 points) - Requires DD214 or document showing dates of service and type of discharge. If this has been submitted previously and is on file with this P. O. BOX 304100 areas. Complete all parts of office, you may disregard this requirement. Note: Must be active duty for other than training purposes. MONTGOMERY, ALABAMA 36130-4100 the application. Applications not prop- erly completed will be returned. Photo- 2 ( ) Disabled Veteran (10 points) - Requires DD214 or other document as above and letter of disability from V.A. dated within last 6 months. V.A. letter must be kept WWW.PERSONNEL.ALABAMA.GOV copied and facsimile applications will updated until register is established or you lose the extra 5 points. FAX: (334) 242-1110 be accepted. 3 ( ) Deceased Veteran’s spouse (10 points) - Requires DD214 or other document as above and marriage and death certificates. Cannot be claimed if spouse remarries. 4 ( ) Disabled Veteran’s spouse (10 points) - Requires DD214 or other document as above and V.A. letter of disability dated within last 6 months. Cannot be claimed ENTER LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER BELOW unless still married to disabled veteran who because of this disability is not them self qualified. 5 ( ) Permanently Disabled Veteran (10 points) - Requires DD214 or other document as above indicating veteran is permanently disabled or DD214 or other document and V.A. letter indicating permanent disability. Print All Information Legibly Job Title of Examination (one per application): Option (if applicable):

COMPLETE THIS SECTION IN ORDER TO BE SCHEDULED FOR WRITTEN EXAMS WrittenWritten exams will be given in the places below for which a sufficient numbernumber ofof applicantsapplicants expressexpress preference.preference. IndicateIndicate byby numbernumber youryour 1st,1st, 2nd 2nd and and 3rd 3rd choices. choices. 31 ( ) Birmingham Alexander City 6 4 (( )) Jacksonville Decatur 96 (( )) Montgomery Jacksonville 11 8 ( ( ) ) Florence Mobile 13 10 ( ( ) ) Huntsville Selma 12 ( ) Tuscaloosa Full Name______53 ( ) Dothan Birmingham 8 5 (( )) Mobile Dothan 107 (( )) Selma Linden 12 9 ( ( ) ) Tuscaloosa Montgomery 1411 ( ( ) ) TroyFlorence 13 ( ) Huntsville First Middle Last IfIf youyou qualify,qualify, you you will will receive receive a anotice notice showing showing the the place place and and time time you you are areto report to report for thefor exam.the exam. Mailing Address ______House or Apartment Number Street WhereWhere did you learn of this job? (check all that apply) ______City State County Zip Code E-mail Address 1 ( ) State EmploymentCareer Center Service 5 ( ) Friend/Relative 9 ( ) Legislative Representative 13 ( ) TV/Radio Commercial 2 ( ) Job Announcement Notice 6 ( ) Dept. News Bulletin 10 ( ) State Recruiter / Counselor 14 ( ) State Personnel Dept. WebsiteWebsite Telephone Number: Home (____)______Cell (____)______Work (____)______3 ( ) Newspaper 7 ( ) Rehabilitation Services 1111 ( ) State Personnel Dept. Information Board 15 ( ) Other WebsiteWebsite Area Code Area Code Area Code 4 ( ) College Placement/Career OfficeOffice 8 ( ) High School Counselor 12 ( ) Outreach Program (i.e. Church) 16 ( ) Other ______The following information is required for governmental reporting or record keeping purposes: AVAILABILITYAVAILABILITY Date of Birth ______Sex (check one) 1. ( ) Male 2. ( ) Female 81 - Northwest Alabama 84 - Jasper/ 87 - East Central Alabama 90 - Montgomery Area 93 - South Central (Month) (Day) (Year) 17 Colbert WinfieldWinfield Area 08 Calhoun 01 Autauga Alabama 30 Franklin 29 Fayette 09 Chambers 26 Elmore 07 Butler 30 Franklin 29 Fayette 09 Chambers 26 Elmore 07 Butler Race (check one) 1. ( ) White 2. ( ) Black 3. ( ) Hispanic 4. ( ) Asian or Pacific Islander 5. ( ) American Indian or Alaskan Native 6. ( ) Other 39 Lauderdale 38 Lamar 14 Clay 81 82 43 Lowndes 18 Conecuh 40 Lawrence 47 Marion 15 Cleburne 51 Montgomery 20 Covington 40 Lawrence 47 Marion 15 Cleburne 83 51 Montgomery 20 Covington 64 WalkerWalker 19 Coosa 21 Crenshaw 67 Winston 56 Randolph 27 Escambia EDUCATION: CIRCLE OR BRACKET THE HIGHEST GRADE OF SCHOOL COMPLETED. ED 67 Winston 56 Randolph 84 27 Escambia 61 TalladegaTalladega 50 Monroe High School Diploma or GED? ( ) Yes ( ) No 1 2 3 4 5 6 7 8 9 10 11 12 College 1 2 3 4 LC 62 TallapoosaTallapoosa 86 82 - Huntsville/ 85 - TuscaloosaTuscaloosa Area 88 - Southwest Alabama 87 91 - Phenix City 94 - Dothan Area PROVIDE INFORMATION ON ALL SCHOOLS ATTENDED. SPECIFY UNDERGRADUATE OR GRADUATE WORK. IF ONLINE, INDICATE BY *ASTERISK. Decatur Area 04 Bibb 12 Choctaw 85 TroyTroy Area 16 CoffeeCoffee Dates of Attendance Credit Hours Did You 36 Jackson 32 Greene 13 Clarke 03 Barbour 23 Dale Month/Year Earned Graduate? Type of Degree 42 Limestone 33 Hale 46 Marengo 06 Bullock 31 Geneva Name and Location of School From To Sem. Qtr. Yes No and Date Major 45 Madison 54 Pickens 65 Washington 41 Lee 34 Henry 45 Madison 54 Pickens 65 Washington 89 90 41 Lee 34 Henry ______48 Marshall 60 Sumter 44 Macon 35 Houston 48 Marshall 60 Sumter 91 44 Macon 35 Houston 52 MorganMorgan 63 TuscaloosaTuscaloosa 55 Pike ______88 57 Russell ______83 - Northeast Alabama 86 - Birmingham Area 89 - Selma/Clanton Area 93 92 - Mobile Area 95 - Statewide 10 Cherokee 05 Blount 1111 Chilton 94 02 Baldwin ( YouYou will be PROFESSIONAL LICENSE OR CERTIFICATE 25 Dekalb 22 Cullman 24 Dallas 49 Mobile considered for License/Certificate Issued By Field/Trade/Specialization License/Certificate No. Issue Date Expiration Date 28 Etowah 37 JeffersonJefferson 53 Perry 92 vacancies through-through- 58 Shelby 66 WilcoxWilcox out the state. ______59 St. Clair Relocation may 59 St. Clair Relocation may ______be necessary) LIST COURSES SUCCESSFULLY COMPLETED (AND HOURS EARNED) WHICH ARE PARTICULARLY RELATED TO POSITION (attach additional sheets, if needed) Please answer the following questions with care. List in the spaces provided those areas of the state in which you would accept employment. YouYou will be ______considered for employment only in the locations you indicate. YouYou may choose a combination of up to seven counties and/or regions from the list above. If you list a region, you will be considered available for all counties in that region. The counties in each region are listed alphabetically below the region. ______YouYou will not be considered for jobs involving overnight travel or shift workwork unless you so indicate. CERTIFICATION STATEMENT List the numbers of up to 7 counties and/or regions where you are willing to work ______I hereby certify, under penalty of perjury, that all statements on or attached to this application are true, correct, and complete. I further If you want to be considered for appointment by only certain state agencies, indicate here ______agree and understand that any false or deceptive information herein, regardless of time of discovery, may cause forfeiture on my part of any Enter the earliest date you will be available to interview for employment. (Your name will not appear on a list of eligibles until this date.) ______employment in the service of the State of Alabama and may prohibit me from being considered for future employment. I understand that all Month Day YearYear information on this application is subject to verification, and I consent to criminal history background, military service, and employment WillWill you accept work involving overnight travel? ( ) YesYes ( ) No WillWill you accept part-time work? ( ) YesYes ( ) No checks. I agree to allow my employer/prospective employer to receive a copy of my Alabama Background Check report through ALEA. WillWill you accept temporary work? ( ) YesYes ( ) No Will you accept conditional work? ( ) Yes ( ) No If employed, I agree to electronic deposits of my payroll check and other state payments; and consistent with applicable laws, to receive compensatory time off in lieu of overtime compensation for any overtime hours worked. The State Personnel Department is not responsible WhichWhich shiftsshifts areare youyou willingwilling toto work?work? 0.0. ( ) allall shiftsshifts 1. ( )) 1st onlyonly 2. ( )) 2nd2nd onlyonly 3.3. (( )) 3rd3rd onlyonly 4.4. (( )) 1st andand 2nd2nd onlyonly 5.5. (( )) 1st1st andand 3rd3rd onlyonly 6.6. ( ) 2nd and 3rd3rd onlyonly for late receipt of applications due to mail service or faxing malfunctions.

Signature______Date______NOTE: YourYour name will be placed on inactive status forfor this class afterafter declining threethree offers of employment consideration oror failing to replyreply to an agency’sagency’s inquiry concerning youryour availability.availability. YourYour name may be restoredrestored to the active registerregister by written request.request. Your name may be removed from an employment register for any disqualifying reason. AN EQUAL OPPORTUNITY EMPLOYER