Monroe

ounty

nterprises
EMPLOYMENT APPLICATION

Provide all information requested by printing in ink or keying. Use the tab key to move through the document.

GENERAL INFORMATION
Name (Last)

(First)

Humphreys

Destiny

Address (Mailing Address)

(City)

114 Julie Lane

Forsyth

(Middle
Initial)
(Stat
e)

GA

E-mail Address

Home Telephone

(478) 297 - 9849

S.
(Zip)

Cell Phone

31029

(478) 993 - 7761

s.Destiny.Humphreys@mcshools.org

POSITION
Will Accept:
Part-Time

Position or Type of Employment Desired

Registered Nurse
Have you ever been employed at the Monroe County Enterprises before?
Yes
No
Are you able to perform the essential functions of the job you are applying
for, with or without reasonable accommodation?
Yes
No

Full-Time

Date Available: 08/26/2026

Salary Desired

$5000/monthly

EDUCATION AND TRAINING

School or
Institution

Name and Address of School

Major/Study

Beginning
& Ending
Year

Degree

Mary Persons High School

High School
Gordon College
College Name
College Address 419 College Drive
Barnesville, Georgia 30204
College City &
State
Special Abilities and Skills (3 tasks from CIS)
Managing Files, Leadership, Assisting Patients

Nursing
Nursing

Extracurricular Activities (at least 2 areas of

Present Community and Professional

Affiliations (at least 2)

interest/hobby)
Soccer, Track, volleyball

2017-2021
2021-2026

Diploma
BA

Professional Certificates or Licenses Held (Yes

or No)

Yes

Youth Group, Volunteering, Bible Studies

Languages Read, Written or Spoken Fluently Other Than English

Yes

REFERENCES

List below names and addresses of persons who are qualified to answer questions concerning your fitness for the
position(s) you seek other than those listed in your credential file. (3 classmates from THIS class. Get a sheet of
paper and Go to the L Drive folder REFERENCES jot down the information and come back to this
document and type it in.)

Name
Sidney Leaptrot

Position
Middle School
Teacher

Address
602 Old Cabiness Road

AN EQUAL OPPORTUNITY EMPLOYER

Telephone
478-501-2449

Jordan Leaptrot
Julia Jenkins

Middle School
Teacher
Physician
Assistant

602 Old Cabiness Road

478-501-3018

300 Jenkins Road

478-394-5955

WORK EXPERIENCEMost recent first, include voluntary work and military experience
Employer Webster Development
Address P.O Box 55621
Job Title Medical Assistant
Specific Duties (Maximum 350 characters)
lifting heavy objects
assembling products
budget reports
taking pictures
x filing
washing/cleaning vehicles
X typing
x copying
running errands

x recording

assisting the director/boss

customer service
driving/delivering
answering phone

x data entry

Telephone Number (478) 994 - 6186

Number Employees Supervised 2
operating heavy machinery

faxing

cleaning

X supervising 1 / 2
x stocking
x organizing
Reason For Leaving Graduated College

inventory control

cutting/washing hair
x handling medicine

Hours Per Week

15-20
Last Salary
$11/hour

handling various reports

repairing equipment

x ordering/buying supplies

x counseling

From (Month/Year)
October/2023
To (Month/Year)
March/2026

Supervisor
S. Dorsey

May We Contact This Employer?

No

Yes

I certify the information contained in this application is true, correct, and complete. I understand that, if
employed, false statements reported on this application may be considered sufficient cause for dismissal.
You will enter an electronic signature. Click in the gray box beside Signature of Applicant select any
script or cursive style font type your first and last name (capitalize the first letter of each).

Signature of Applicant: Destiny S. Humphreys

Date: 08/31/2026

AN EQUAL OPPORTUNITY EMPLOYER