Printable Maryland State 100 Application Template

The Maryland State 100 Application form is a crucial document used for applying to various job positions within the state government. It serves as part of the examination process, ensuring that applicants meet the necessary qualifications for the roles they seek. Completing this form accurately is essential for your consideration in the hiring process.

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

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The Maryland State 100 Application form is an essential document for individuals seeking employment within the state government. This application serves as a vital part of the examination process and must be completed accurately to ensure eligibility for the desired position. Applicants should first review the job announcement to confirm they meet the minimum qualifications. The form requires personal information, including name, contact details, and social security number, as well as educational background and work experience. Each section is designed to capture relevant details that demonstrate the applicant's qualifications for the job. Additionally, the application includes questions about specialized training, language proficiency, and veteran status, which may enhance an applicant's chances. It’s important to note that a separate application is necessary for each job title unless specified otherwise. Completing the form thoroughly and adhering to submission guidelines will help streamline the hiring process and improve the likelihood of securing an interview.

Maryland State 100 Application Preview

St at e of Maryland

MAIL APPLICATION TO THE ADDRESS

INDICATED ON THE JOB ANNOUNCEMENT

For Job Announcements visit: www.dbm.maryland.gov

or call 410-767-4850

(OFFICE USE ONLY)

Class Code

APPR. _______ DISAPPR. _______ BY _____

Reason: ________________________________

_______________________________________

Pending Code:

SOCIAL SECURITY NUMBER:		PRINT OR TYPE ALL INFORMATION


	This application is part of the examination process. Please read the minimum qualifications section of the job announcement
	before completing this application. You must meet all of the qualifications to be considered.

Applying For:

Job Title:

Announcement #:

(A separate application is required for each job title unless otherwise indicated.)

Name and Contact Information:

Name:

Last

First

Address:

Street

City

County

State

Zip Code

Home Phone:

Work Phone:

E-mail:

Education and Training:

Do you have a high school diploma or GED?

Yes

If not, what is the highest grade that you completed?

School:

Address (City, State):

Dates attended:

Major course of study:

From

COLLEGE AND GRADUATE SCHOOL EDUCATION

Name/Location of School(s)

Dates Attended

Major

# of Credits

Type of Degree

Degree Earned?

Completed

(Yes or No)

SPECIALIZED TRAINING OR CLASSES RELEVANT TO THE JOB

Title of Program/Course(s)

Company/School

Dates Attended

# of Credits Earned

Diploma/Certificate

Received?

Please submit a copy of any relevant professional or trade licenses or certificates with this application.

For positions requiring a driver’s license, please attach a copy of your license or write on a separate sheet of paper

your driver’s license number, class, state of issuance and expiration date.

MS-100 REV. 3/10

STATE OF MARYLAND – AN EQUAL OPPORTUNITY

WORK EXPERIENCE:

List below, beginning with your most recent position, all of your work experience, including military service and all volunteer activities. Attach additional 8 1/2" x 11” sheets of paper if necessary. If your title and duties changed in the course of your service in any one organization, indicate such changes clearly and as separate employment. Please do not submit a resume in lieu of completing this portion of the application. Be sure that the information included in this section demonstrates that you meet the experience qualifications for the job for which you are applying.

Job Number 1: (Current or Most Recent)

Name of Employer:	Employer’s Address (Street, City, State, Zip Code):


Type of Business:	Supervisor’s Name and Phone Number:


Your Job Title:	Do you supervise other employees?				Job Titles of Those You Supervise:
	Yes	No	How many?

Dates of Employment (From: Month/Day/Year To: Month/Day/Year):	Is your position considered full-time? Yes					No

	How many hours do you work per week?

Job Duties:
Reason For Leaving:


Job Number 2:
Name of Employer:	Employer’s Address (Street, City, State, Zip Code):


Type of Business:	Supervisor’s Name and Phone Number:


Your Job Title:	Did you supervise other employees?				Job Titles of Those You Supervised:
	Yes	No	How many?

Dates of Employment (From: Month/Day/Year To: Month/Day/Year):	Was your position considered full-time?			Yes		No

	How many hours did you work per week?

Job Duties:
Reason For Leaving:


Job Number 3:
Name of Employer:	Employer’s Address (Street, City, State, Zip Code):


Type of Business:	Supervisor’s Name and Phone Number:


Your Job Title:	Did you supervise other employees?				Job Titles of Those You Supervised:
	Yes	No	How many?

Dates of Employment (From: Month/Day/Year To: Month/Day/Year):	Was your position considered full-time?			Yes		No

	How many hours did you work per week?

Job Duties:
Reason For Leaving:

ELIGIBILITY FOR VETERANS’ CREDIT

A copy (not an original) of your proof of eligibility (DD 214) for Veterans’ Credit must be in this office and completely verified before Veterans’ Credit will be approved. Proof will only need to be submitted once.

Permanent State employees do not need to submit proof of eligibility for Veterans’ Credit.

Job Number 4:

Name of Employer:	Employer’s Address (Street, City, State, Zip Code):


Type of Business:	Supervisor’s Name and Phone Number:


Your Job Title:	Did you supervise other employees?				Job Titles of Those You Supervised:
	Yes	No	How many?

Dates of Employment (From: Month/Day/Year To: Month/Day/Year):	Was your position considered full-time?			Yes		No

	How many hours did you work per week?

Job Duties:
Reason For Leaving:


Job Number 5:
Name of Employer:	Employer’s Address (Street, City, State, Zip Code):


Type of Business:	Supervisor’s Name and Phone Number:


Your Job Title:	Did you supervise other employees?				Job Titles of Those You Supervised:
	Yes	No	How many?

Dates of Employment (From: Month/Day/Year To: Month/Day/Year):	Was your position considered full-time?			Yes		No

	How many hours did you work per week?

Job Duties:
Reason For Leaving:

Are you fluent in a language other than English? (if required for the job for which you are applying) Yes If yes, please list:

“UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.”

This provision does not apply to applicants for law enforcement positions pursuant to Labor and Employment Article, Section 3-702 (b) Annotated Code of Maryland.

Have you ever been convicted of any violation of law other than a minor traffic violation? Yes	No
If yes, give the date, place of conviction, charge and disposition of each case. Note: A conviction record will not necessarily bar you
from employment. (Please write this information on a separate sheet of paper and attach it to this application.)

DATE: __________________________ SIGNATURE OF APPLICANT: _________________________________________________

In which counties will you accept employment? Please check the box on the left if you will work in all of the counties in that row, OR, circle individual counties of interest.

10	GARRETT - 11, ALLEGANY - 12, WASHINGTON -13

20	FREDERICK - 21, CARROLL - 22, MONTGOMERY - 23

30	BALTIMORE CITY - 31, BALTIMORE COUNTY - 32, HOWARD - 33

40	HARFORD - 41, CECIL - 42, KENT - 43

50	PRINCE GEORGE’S - 51, CHARLES - 52, CALVERT - 53, ST. MARY’S - 54

60	ANNE ARUNDEL - 61, QUEEN ANNE’S - 62, TALBOT - 63, CAROLINE - 64

70	DORCHESTER - 71, WICOMICO - 72, SOMERSET - 73, WORCESTER - 74

How did you find out about this recruitment? Check the correct box and add information such as the name of the publication or site.

OPSB Website

Other Website

Newspaper ad, paper name

State Personnel Office location

DLLR Job Service location

Job Fair

Other Media

Other

AVAILABLE FOR EMPLOYMENT WHICH IS:

Full-time

Part-time Temporary Contractual

After a test notice is received, applicants with disabilities who require accommodations should contact the Office of Personnel Services and Benefits at (410) 767-4921, or Toll Free: 1 (800) 705-3493. TTY/TT users call the Maryland Relay Service at (800) 735-2258 or 7-1-1 in Maryland.

Applications must be received by the Office of Personnel Services and Benefits (or the recruiting agency) by either the close of business on the closing date, or postmarked by the closing date, as specified on the job announcement for which you are applying. A receipt will be mailed if a self-addressed, stamped envelope is attached. NOTIFY THE OFFICE OF PERSONNEL SERVICES AND BENEFITS IN WRITING OF A CHANGE IN NAME, ADDRESS OR TELEPHONE NUMBER. YOU MUST BE LEGALLY AUTHORIZED TO WORK IN THE UNITED STATES UNDER THE UNITED STATES IMMIGRATION REFORM AND CONTROL ACT OF 1986.

YOU MUST MEET ALL OF THE QUALIFICATIONS TO BE ELIGIBLE FOR APPOINTMENT. VERIFICATION WILL BE COMPLETED BY THE APPOINTING AUTHORITY. YOU MAY BE TESTED FOR ILLEGAL DRUG USE. IF SELECTED FOR A POSITION IN THE SKILLED OR PROFESSIONAL SERVICE, YOU MAY BE GIVEN A MEDICAL EXAMINATION TO DETERMINE YOUR ABILITY TO PERFORM JOB-RELATED FUNCTIONS.

I hereby affirm that this application contains no willful misrepresentation or falsifications and that this information given by me is true and complete to the best of my knowledge and belief. I am aware that should investigation at any time disclose any misrepresentation or falsification, my application will be disapproved, my name removed from the eligible list, and that I will not be certified for employment in any position under the jurisdiction of the Department of Budget & Management. I am aware that a false statement is punishable under law by fine or imprisonment or both.

DATE: _____________________ SIGNATURE OF APPLICANT: _______________________________________________________________

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

(Remove this section of the application prior to the interview process.)

TO FURTHER ITS COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT, THE STATE OF MARYLAND REQUESTS APPLICANTS TO PROVIDE, VOLUNTARILY, THE FOLLOWING INFORMATION. THIS INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY BY AUTHORIZED PERSONNEL.

BIRTH DATE: _____________	MALE
Month/Day/Year

FEMALE

ARE YOU A U.S. CITIZEN OR LEGAL ALIEN? YES

RACE/ETHNIC IDENTIFICATION – PLEASE CHECK ALL THAT APPLY

Are you of Hispanic or Latino origin? Yes No

(A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)

Select one or more of the following racial categories:

American Indian or Alaska Native (A person having origins in any of the original peoples of North or South America, including Central America, and who maintains tribal affiliations or community attachment.)

Asian (A person having origin in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.)

Black or African American (A person having origins in any of the black racial groups of Africa.)

Native Hawaiian or other Pacific Islander (A person having origins in the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)

White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)

STATE OF MARYLAND – AN EQUAL OPPORTUNITY EMPLOYER

Click for Maryland State 100 Application File

Form Attributes

Fact Name	Description
Application Purpose	The Maryland State 100 Application form is used as part of the examination process for job applicants. Candidates must meet all qualifications listed in the job announcement to be considered.
Eligibility Requirements	Applicants must be legally authorized to work in the United States under the Immigration Reform and Control Act of 1986. Verification of eligibility will be conducted by the appointing authority.
Veterans' Credit	To receive Veterans' Credit, applicants must submit a copy of their DD 214. This proof must be verified before any credit is granted, although permanent state employees are exempt from this requirement.
Equal Opportunity Statement	The State of Maryland is committed to equal opportunity employment. It prohibits employers from requiring lie detector tests as a condition of employment, per Labor and Employment Article, Section 3-702 (b) Annotated Code of Maryland.

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