Employment Application

Contact Information

1. First Name
2. Middle Name
3. Last Name
4. Address
5. City
6. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
7. Zip
8. Phone
9. Email
10. Position you are applying for: Choose an open position. Assistant County Attorney- Juvenile Courts Medical Examiner Investigator Special Deputy Truck Driver- Delmar Shed
11. Date Available
12. Are you 18 or Older? Please Select Yes No
13. Do you have a legal right to work in the United States full-time? Please Select Yes No
14. Have you ever been employed by Clinton County? Please Select Yes No
15. Where did you learn about this position? Please Select Linkedin County Website Indeed College Job Board Referral Facebook Newspaper
Employed Start Date:
Employed End Date:
Employed Position
Reason for Leaving

Education

High School

16. Name and Location
17. Did you Graduate? Please Select Yes No No, but received GED

College or Trade School

18. Name and Location
19. Did you Graduate? Please Select Yes No
20. Major/Subject
Add College or Trade School

College or Trade School 2

Name and Location

Did you Graduate? Please Select Yes No

Major/Subject

Employment History

List employment from the past 10 years, starting with your most recent job. Account for any time period that you were unemployed by stating the nature of your activities.

Employer 1

21. Employer Name
22. Job Title
23. Address
24. City
25. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
26. Zip
27. Phone
28. Start Date
29. End Date
30. Current/Ending Pay
31. Supervisor Name
32. Work Performed
33. Reason For Leaving
34. Can we contact current employer? Please Select Yes No
Add Employer

Employer 2

Employer Name

Job Title

Address

City

State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

Phone

Start Date

End Date

Current/Ending Pay

Supervisor Name

Work Performed

Reason For Leaving

Can we contact current employer? Please Select Yes No

Add Employer

Employer 3

Employer Name

Job Title

Address

City

State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

Phone

Start Date

End Date

Current/Ending Pay

Supervisor

Work Performed

Reason For Leaving

Can we contact current employer? Please Select Yes No

Additional Employers

Upload Attachments

35. Cover Letter
    only PDF files are allowed
36. Resume (Required)
    only PDF files are allowed

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References

Please list three personal references, other than prior employers or relatives, whom we can contact.

Reference 1

37. Name:
38. Phone:
39. How long have you known this reference?
40. Occupation:

Reference 2

41. Name:
42. Phone:
43. How long have you known this reference?
44. Occupation:

Reference 3

45. Name:
46. Phone:
47. How long have you known this reference?
48. Occupation:

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Additional Information

49. List any professional, trade groups, organizations, machinery/tools operated in the past, and/or special skills that you consider relevant to your ability to perform this job.
50. Were you in the Military? Please Select Yes No
Branch
Do you have any experience from your military service that would be relevant to the job(s) for which you are applying? If yes, please explain:

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51. Have you ever been convicted of a felony?
    For purposes of these questions, convicted includes plead guilty, plead no contest, or been given a deferred sentence of judgment. Please Select Yes No
If yes, please explain.
Note: A conviction will not automatically disqualify an applicant for a particular job and that the type and seriousness of the crime, the frequency of violoations, the date of conviction, and the applicant's entire work and educational history will be considered.

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Job Description

52. Have you read the job description? Please Select Yes No
53. Do you understand the requirements? Please Select Yes No
54. Can you perform the requirement of this job with or without reasonable accommodations? Please Select Yes No

Driver's License

55. If the job requires, do you have the appropriate valid driver's license? N/A Yes No
Driver's License #
License Type
State of License Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Have you had any moving violations? Please Describe:

Background Checks

To ensure that individuals who are employed by Clinton County are well qualified and to ensure that Clinton County maintains a safe and productive work environment, the county will conduct pre-employment background checks on all applicants who accept an offer of employment. Background checks may include verification of any information on the applicant’s resume or application form, a criminal history background check, a check of any relevant abuse registries, a check of the applicant’s driving record, and any other check deemed to be relevant by Clinton County.

All offers of employment are conditional on receipt of a background check report that is acceptable to Clinton County. All background checks are conducted in conformity with the Federal Fair Credit Reporting Act, the Americans with Disabilities Act, and the state and federal privacy and antidiscrimination laws. Reports are kept confidential and are only viewed by individuals involved in the hiring process.

If information obtained in a background check would lead Clinton County to deny employment, a copy of the report will be provided to the applicant, and the applicant will have the opportunity to dispute the reports accuracy. If the County’s background check includes a criminal record check and the check indicates that the applicant has a criminal history, the applicant will be given an opportunity to provide information regarding his/her criminal history. This must be provided within 5 business days of receiving the information. At any time during employment, additional checks, such as a driving record or credit report, may be made if appropriate and job related.

Applicant's Statement

By typing my name below, I certify that answers given herein are true and complete.

I authorize investigations of all statements contained in this Application for Employment as may be necessary in arriving at an employment decision.

I authorize Clinton County to conduct a check of the status of my driver’s license and my driving record and agree to sign a separate authorization for this specific purpose.

This Application for Employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with Clinton County is “at will,” which means that the Employee may resign at any time, and the Employer may discharge the Employee at any time with or without cause. It is further understood that the “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of Clinton County.

I understand that any offer of employment that is extended to me is considered to be a conditional offer and is subject to successful completion of all required background checks. Identifying information such as my social security number and driver’s license number will be requested at the post-offer, pre-employment stage.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I will be required to abide by all rules and regulations of the Employer.

I agree to give Clinton County permission to complete appropriate background checks and agree to sign separate permission/authorization forms so that this can be accomplished.

Your Signature

56. Signature Please type your full name to serve as an electronic signature.
57. Today's Date