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Position you are applying for:
Choose an open position.
Date Available
Are you 18 or older?
Please Select
Yes
No
Do you have a legal right to work in the United States full-time?
Please Select
Yes
No
Have you ever been employed by Jasper County?
Please Select
Yes
No
Employed Start Date:
Employed End Date:
Employed Position
Reason for Leaving
Do you have relatives employed by us?
Please Select
Yes
No
If yes, please list the relatives.
How did you learn about this job opening?
Education
High School
Name and Location
Did you graduate?
Please Select
Yes
No
No, but received GED
College or Trade School
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
Employer Name
Job Title
Address
City
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
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New Mexico
New York
North Carolina
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
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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
Have you ever been discharged from a job?
Please Select
Yes
No
If yes, please list the employer, dates, and provide an explanation
Optional: Upload Resume
Resume
only PDF files are allowed
References
Please list three personal references, other than prior employers or relatives, whom we can contact.
Reference 1
Name
Phone
How long have you known this reference?
Occupation
Reference 2
Name
Phone
How long have you known this reference?
Occupation
Reference 3
Name
Phone
How long have you known this reference?
Occupation
Military Services
Were you in the Military?
Please Select
Yes
No
Chapter 35C of the Code of Iowa provides certain rights including preference in hiring if equally qualified to certain Veterans of United States Military Service. Qualification for these rights is defined in the statute.
Additional Information
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.
This may also include relevant professional licenses. if listing licenses, please include the license type, certificate number, state of issue, and expiration date.
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.
Job Description
Have you read the job description?
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Yes
No
Do you understand the requirements?
Please Select
Yes
No
Can you perform the requirement of this job with or without reasonable accommodations?
Please Select
Yes
No
Driver's License
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:
Abuse Registry and Criminal History Waiver
I hereby give permission for Jasper County, Iowa to conduct a child and/or dependent adult abuse check and an Iowa criminal history
check with the Division of Criminal Investigation. Any information maintained by DCI may be released and I understand that it will be
used by the requestor only for licensing, employment or volunteer purposes.
Signature
Please type your full name to serve as an electronic signature.
Date
Confidential Information
As required, we comply with government regulations including Affirmative Action obligations where they apply.
In an effort to comply with requirements regarding government record keeping, reporting and other legal obligations, we ask that you complete this applicant survey. Your cooperation is appreciated.
Please be advised that your survey is not part of your official application for employment. It is considered confidential information that will not be used in any hiring decision.
Please select one.
American Indian or Alaskan Native: persons having origins in any of the original peoples of North America and who maintain cultural identification through tribal affiliation or community recognition.
White, not of Hispanic Origin: persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
Black, not of Hispanic Origin: persons having origins in any of the Black racial groups of Africa.
Asian, or Pacific Islander: persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands.
Hispanic: persons of Mexican, Puerto Rican, Cuban, Central of South America, or other Spanish culture or origin, regardless of race.
Other
Gender
Please Select
Male
Female
Disabled/Veteran Classifications
Disabled Person: Federal regulation defines a disabled person as one who (1) has a physical or mental impairment which substantially limits one or more of such person's major life activities, (2) has a history of such impairment, or (3) is regarded as having such an impairment
Vietnam Veteran: Federal regulations define a veteran of the Vietnam Era as one who (1) served on active duty for a period of more that 180 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was discharged or released with other than a dishonorable discharge, (2) was discharged or released from active duty for a service connected disability if any part of such active duty was performed between August 5, 1964 and May 7. 1975.
Special Disability Veteran (30% or more disability): Federal regulations defines a special disabled veteran as one who (1) is entitled to compensation under laws administered by the Veterans' Administration for disability rated 30% or more, (2) was discharged or released from active duty because of a service-connected disability.
Applicant's Statement
I certify that answers given herein are true and complete.
I authorize investigation of all statements contained in this Application for Employment as may be necessary in arriving at an employment decision.
I authorize Jasper County to conduct a check of the status of my driver’s license and my driving record and agree to sign an 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 Jasper County is “at will” nature, 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 Jasper 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, also, that I am required to abide by all rules and regulations of the Employer.
I agree to give Jasper County permission to complete appropriate background checks and agree to sign permission/authorization documents so that this can be accomplished.
Your Signature
Signature
Please type your full name to serve as an electronic signature.
Today's Date