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Fill in Your Mississippi Application Template

The Mississippi Application Form is a document required for individuals seeking employment with the state of Mississippi. This form collects essential personal, educational, and work history information to assess eligibility for various positions. Completing the application accurately is crucial, as incomplete submissions may be deemed invalid.

To start your application process, please fill out the form by clicking the button below.

Make This Mississippi Application

Fill in Your Mississippi Application Template

Content Overview

The Mississippi Application form is a crucial document for individuals seeking employment within the state. It requires applicants to provide a range of personal information, including their name, address, and contact details. Applicants must indicate their preferred method of communication regarding their application status, whether by email or paper. The form also includes sections for educational background, where candidates can list their highest level of education and any degrees obtained from colleges or universities. Additionally, applicants are asked to detail their work history, including previous employers, job titles, and responsibilities. Special attention is given to veterans, who must provide proof of service if applicable. The form emphasizes the importance of attaching the "Supplemental Questions" page, which is necessary for certain job applications, and reminds applicants to ensure their submission is complete to avoid invalidation. Overall, this application form serves as a comprehensive tool for gathering essential information that aids in the hiring process for state positions.

Mississippi Application Preview

STATE OF M I SSI SSI PPI APPLI CATI ON

Re t u r n Com ple t e d Applica t ion t o: M ississippi St a t e Pe r son n e l Boa r d

210East Capit ol St reet , Suit e 800 Jackson, MS 39201

w w w . m spb. m s. gov

For St a ff/ Off icia l U se On ly

Re ce iv e d: __________________

I m por t a n t ! Ple a se Re a d Be for e y ou be gin t h e a pplica t ion pr oce ss:

Applica n t s m u st com ple t e a n d a t t a ch t h e “Su pple m e n t a l Qu e st ion s” pa g e w h e n a pp lica b le . This page is locat ed on t he MSPB

w ebsit e Job Openings scr een .

Scr oll dow n t o t he bot t om of t he scr een and click t he pr efer r ed j ob; w hen t he descr ipt ion is display ed,

click “ Pr int Job I nfor m at ion . ”

Applicat ions failing t o include t his page or lack ing sufficient infor m at ion w ill be r et ur ned t o t he applicant

as inv alid. Please ensur e y our applicat ion is r eceiv ed by t he closing dat e as indicat ed on t he j ob post ing.

- TYPE OR PRI N T I N BLACK I N K-

JOB I N FORM ATI ON

POSI TI ON # :

POSI TI ON TI TLE:

PERSON AL I N FORM ATI ON

FI RST NAME

MI DDLE I NI TI AL

LAST NAME

ADDRESS

CI TY

STATE

ZI P

HOME PHONE

ALTERNATE PHONE

MONTH AND DATE OF BI RTH

WHI CH METHOD DO YOU PREFER TO BE NOTI FI ED ABOUT YOUR

APPLI CATI ON STATUS?

EMAI L OR

PAPER

EMAI L ADDRESS

ED UCATI ON

WHAT I S YOUR HI GHEST LEVEL OF EDUCATI ON:

Som e High School

Som e College

Associat e’s Degree

Mast er ’s Degree

Doct or at e Degr ee

High School

Technical College

Bachelor ’s Degr ee

Specialist ’s

Degree

H I GH SCH OOL ED U CATI ON

DI D YOU GRADUATE FROM HI GH SCHOOL/ RECEI VE A G. E. D. ?

YES

I F NO, WHAT WAS THE HI GHEST GRADE LEVEL COMPLETED?

COLLEGE/ UN I V ERSI TY ED UCATI ON

SCHOOL NAME

DEGREE RECEI VED

DATES ATTENDED

DI D YOU GRADUATE?

SEMESTER

QUARTER

# OF UNI TS COMPLETED:

YES

SCHOOL LOCATI ON ( CI TY/ STATE)

MAJOR

SCHOOL NAME

DEGREE RECEI VED

DATES ATTENDED

DI D YOU GRADUATE?

SEMESTER

QUARTER

# OF UNI TS COMPLETED:

YES

SCHOOL LOCATI ON ( CI TY/ STATE)

MAJOR

SCHOOL NAME

DEGREE RECEI VED

DATES ATTENDED

DI D YOU GRADUATE?

SEMESTER

QUARTER

# OF UNI TS COMPLETED:

YES

SCHOOL LOCATI ON ( CI TY/ STATE)

MAJOR

REV 2/2012

CERTI FI CATES & LI CEN SES

TYPE	DATE I SSUED ( MONTH/ YEAR)	EXPI RATI ON DATE ( MONTH/ YEAR)

LI CENSE NUMBER	I SSUI NG AGENCY	SPECI ALI ZATI ON


TYPE	DATE I SSUED ( MONTH/ YEAR)	EXPI RATI ON DATE ( MONTH/ YEAR)

LI CENSE NUMBER	I SSUI NG AGENCY	SPECI ALI ZATI ON


TYPE	DATE I SSUED ( MONTH/ YEAR)	EXPI RATI ON DATE ( MONTH/ YEAR)

LI CENSE NUMBER	I SSUI NG AGENCY	SPECI ALI ZATI ON

W ORK H I STORY

DATES		EMPLOYER	POSI TI ON TI TLE
From	To

ADDRESS, CI TY, STATE

PHONE NUMBER		SUPERVI SOR ( NAME & TI TLE)

HOURS PER WEEK		SALARY	MAY WE CONTACT THI S EMPLOYER?
			YES	NO

DUTI ES


DATES		EMPLOYER	POSI TI ON TI TLE
From	To

ADDRESS, CI TY, STATE

PHONE NUMBER		SUPERVI SOR ( NAME & TI TLE)

HOURS PER WEEK		SALARY	MAY WE CONTACT THI S EMPLOYER?
			YES	NO

DUTI ES

REV 3/2012

W ORK H I STORY

DATES		EMPLOYER	POSI TI ON TI TLE
From	To

ADDRESS, CI TY, STATE

PHONE NUMBER		SUPERVI SOR ( NAME & TI TLE)

HOURS PER WEEK		SALARY	MAY WE CONTACT THI S EMPLOYER?
			YES	NO

DUTI ES


DATES		EMPLOYER	POSI TI ON TI TLE
From	To

ADDRESS, CI TY, STATE

PHONE NUMBER		SUPERVI SOR ( NAME & TI TLE)

HOURS PER WEEK		SALARY	MAY WE CONTACT THI S EMPLOYER?
			YES	NO

DUTI ES

REV 3/2012

AGEN CY W I D E QU ESTI ON S

1 . ARE YOU CURRENTLY EMPLOYED WI TH THE STATE OF MS? YES

2 . I F YOU ANSWERED “ YES” TO THE PREVI OUS QUESTI ON, I NDI CATE WHI CH AGENCY AND YOUR CURRENT JOB TI TLE. ( I F YOU PREVI OUSLY I NDI CATED “ NO” , PROCEED TO THE NEXT QUESTI ON. )

___________________________________________________________ _____________________________________________________________

		( AGENCY NAME)	( CURRENT JOB TI TLE)
3	. HAVE YOU BEEN SEPRATED WI THI N THE LAST 12 MONTHS FROM THE STATE OF MS DUE TO A REDUCTI ON I N FORCE ( RI F) ? YES				NO
4	. I F YOU ANSWERED “ YES” TO THE PREVI OUS QUESTI ON, I NDI CATE WHI CH AGENCY, YOUR PREVI OUS JOB TI TLE, AND THE DATE OF YOUR RI F
	SEPARATI ON. ( I F YOU PREVI OUSLY I NDI CATED “ NO” , PROCEED TO THE NEXT QUESTI ON. )
_______________________________________________			______________________________________	___________________________________
		( AGENCY NAME)	( PREVI OUS JOB TI TLE)	( DATE OF RI F)
5	. ARE YOU A VETERAN OF THE ARMED FORCES? YES		NO
	( I F YOU I NDI CATED “ YES” , YOU MUST ATTACH A COPY OF YOUR DD214 OR OTHER PROOF OF SERVI CES. )
6	. I F YOU ARE A VETERAN, WERE YOU DECLARED DI SABLED? YES NO
7 . ARE YOU AN ADULT MALE BORN ON OR AFTER JANUARY 1, 1960 WHO REGI STERED FOR SELECTI VE SERVI CE BETWEEN THE AGES OF 18 AND 25?
	YES	NO

TO M EET TH E REQUI REM EN TS OF FED ERAL REGULATI ON S, M SPB N EED S TO COLLECT I N FORM ATI ON ON TH E QUESTI ON S BELOW FOR REPORTI N G PURPOSES ON LY. TH I S I N FORM ATI ON W I LL N OT BE USED FOR M AKI N G EM PLOYM EN T D ECI SI ON S. ( OPTI ON AL)

8 . I NDI CATE YOUR RACE	9 . I NDI CATE YOUR GENDER	10 . AGE GROUP:
AMERI CAN I NDI AN	MALE	UNDER 18
AMERI CAN I NDI AN	FEMALE	18 - 25
WHI TE	FEMALE	18 - 25
WHI TE		26 - 39
HI SPANI C		26 - 39
HI SPANI C		40 - 54
BLACK		40 - 54
BLACK		55 - 69
ASI AN		55 - 69
ASI AN		70+
		70+
Ot her

AD D I TI ON AL I N FORM ATI ON

Addit ional I nfor m at ion ( ot her schools or t r aining; special qualificat ions; honors and aw ar ds; et c. ) :

APPLI CAN T D ECLARATI ON S

By signing t his applicat ion, I cer t ify t hat all st at em ent s m ade herein and on any at t ached docum ent s ar e t r ue and com plet e t o t he best of m y knowledge. I

aut horize t he ver ificat ion of t his infor m at ion by t he Mississippi St at e Per sonnel Boar d and any agency considering m e for em ploym ent . I	know t hat any
m isr epr esent at ion her ein m ay lead t o r ej ect ion of m y applicat ion, r em oval of m y nam e fr om t he list of eligibles, and/ or dism issal fr om	st at e ser vice. I

underst and t hat , as a condit ion of em ploym ent , I will be r equir ed t o pr esent docum ent at ion w hich verifies bot h m y ident it y and m y em ploym ent eligibilit y pur suant t o federal im m igr at ion law .

X _________________________________________________________________	_________________________________________________
SI GNATURE OF APPLI CANT	DATE

REV 3/2012

SU PPLEM EN TAL QU ESTI ON S

Applica n t s m u st com ple t e a n d a t t a ch t h e “Su pple m e n t a l Qu e st ion s” pa g e w h e n a pp lica b le . This page is locat ed on t he MSPB w ebsit e Job Openings scr een . Scr oll dow n t o t he bot t om of t he scr een and click t he pr efer r ed j ob; w hen t he descr ipt ion is display ed, click “ Pr int Job I nfor m at ion . ” Applicat ions failing t o include t his page or lack ing sufficient infor m at ion w ill be r et ur ned t o t he applicant as inv alid. Please ensur e y our applicat ion is r eceived by t he closing dat e as indicat ed on t he j ob post ing.

	AD D I TI ON AL W ORK H I STORY

	JOB I N FORM ATI ON
JOB NUMBER:		POSI TI ON TI TLE:

COLLEGE/ UN I V ERSI TY ED UCATI ON

SCHOOL NAME						DEGREE RECEI VED

DATES ATTENDED				DI D YOU GRADUATE?		SEMESTER		QUARTER
				YES	NO	# OF UNI TS COMPLETED:

SCHOOL LOCATI ON ( CI TY/ STATE)					MAJOR


SCHOOL NAME						DEGREE RECEI VED

DATES ATTENDED				DI D YOU GRADUATE?		DATES ATTENDED
				YES	NO

SCHOOL LOCATI ON ( CI TY/ STATE)					MAJOR

		CERTI FI CATES & LI CEN SES
TYPE				DATE I SSUED ( MONTH/ YEAR)			EXPI RATI ON DATE ( MONTH/ YEAR)

LI CENSE NUMBER				I SSUI NG AGENCY			SPECI ALI ZATI ON


TYPE				DATE I SSUED ( MONTH/ YEAR)			EXPI RATI ON DATE ( MONTH/ YEAR)

LI CENSE NUMBER				I SSUI NG AGENCY			SPECI ALI ZATI ON

			W ORK H I STORY
DATES		EMPLOYER				POSI TI ON TI TLE
From	To

ADDRESS		CI TY						STATE

COMPANY WEBSI TE		PHONE NUMBER				SUPERVI SOR ( NAME & TI TLE)

HOURS WORKED PER WEEK		MONTHLY SALARY				MAY WE CONTACT THI S EMPLOYER?
						YES	NO

DUTI ES

REV 3/2012

Get Mississippi Application File

File Features

Fact Name	Description
Application Submission	Completed applications must be returned to the Mississippi State Personnel Board at 210 East Capitol Street, Suite 800, Jackson, MS 39201.
Supplemental Questions Requirement	Applicants must complete and attach the “Supplemental Questions” page when applicable. This page can be found on the MSPB website under Job Openings.
Deadline for Submission	It is crucial that applications are received by the closing date indicated on the job posting; otherwise, they will be returned as invalid.
Governing Law	The Mississippi Application Form is governed by state employment laws, including regulations set forth by the Mississippi State Personnel Board.

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