DIRECTIONS FOR STANDARD WASHINGTON COUNTY EMPLOYMENT APPLICATION PACKET

Transcription

1 HUMAN RESOURCES DEPARTMENT PETER J. GERMAN, DIRECR OF HUMAN RESOURCES 432 East Washington Street, P.O. Box 1986 West Bend, WI Telephone: (262) TDD: (262) FAX: (262) LL FREE (In State Only) DIRECTIONS FOR STANDARD WASHINGN COUNTY EMPLOYMENT APPLICATION PACKET To be considered for employment you must submit the completed standard Washington County application packet: 1. Complete the Standard Washington County Employment Application, the Advertising Referral Source, and the Voluntary Affirmative Action Information forms by printing or copying and attaching them to an . Complete both pages of the application being sure that it is filled out in its entirety, sign and date. 2. Complete Advertising Referral Source form. 3. Complete the Voluntary Affirmative Action form if you choose to. 4. Mail Completed Forms: Human Resources Department 432 East Washington Street P.O. Box 1986 West Bend WI Fax to: to: Only completed Washington County Employment Applications with accompanying copies of Social Security Cards, Drivers License and required documentation will be accepted for the current recruitments until the deadline. If you have any questions please call

2 WASHINGN COUNTY APPLICATION FOR EMPLOYMENT HUMAN RESOURCES DEPARTMENT 432 EAST WASHINGN STREET P.O. BOX 1986 WEST BEND, WI FAX (262) * PHONE (262) LL FREE - 1 (800) (In State Only) AN EQUAL OPPORTUNITY EMPLOYER Office Use only POSITIONS APPLIED FOR: Full-time Part-time ¾-time Limited Term Seasonal PLEASE PRINT ALL INFORMATION USING INK OR TYPEWRITER (ADD ADDITIONAL SHEETS IF NECESSARY) Name (Last) (First) (M) Date Available For Employment? Present Address (Number & Street) (City, State & Zip Code) Military MEDICAL EDUCATION PERSONAL Permanent Address (Number & Street) (City, State & Zip Code) Social Security Number Home Telephone Business Telephone Do you have a valid Wisconsin Drivers License? Yes No License Number Have you ever worked for Washington County? Yes No Department Dates: School Dates Attended No. of Years Completed Did you Name and Location From To Graduate? High School or G.E.D. Yes No Undergraduate & Graduate College or University Major(s) Yes No Major(s) Yes No Business/Technical/ Trade School or Other Course: Yes No Are you able to perform the essential functions of the job for which you are applying? Yes No If No, please explain: Have you served in the U.S. Armed Service? Date of Service If yes, what branch? Type of charge FOR OFFICE USE ONLY County Typing Test WPM County Steno. Test WPM Form 790 (Revised 4/07)

3 Beginning with your last or present employer, give a comprehensive report of your employment history, including U.S. military service. If additional space is needed, ask for an additional sheet. Failure to fill in all the requested information will cause the application to be removed from consideration. WORK EXPERIENCE Would you object to our contacting any of the above employers? Yes No If so, name and reason: List any non-salary skills or volunteer work not already mentioned, which you feel should be brought to our attention and which you feel would help qualify you for the position you are applying for: Are you related to any county employee or elected official? Yes No If so, please explain: Name: Relationship: Dept.: GENERAL Have you ever been convicted of a felony? Yes No If yes, please explain: I hereby certify that all statements made on or in connection with this application are true, complete and correct to the best of my knowledge and belief, and I understand that my employment may be subject to passing a physical examination and meeting physical qualifications as may be determined by Washington County. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for dismissal. I hereby authorize Washington County to investigate all statements contained in the application and I authorize the release of such factual information without liability for any damage whatsoever incurred in furnishing such information. Signature Date

4 WASHINGN COUNTY ADVERTISING REFERRAL SOURCE (Expandable fields) To enable us to verify our advertising dollars are being used in the best manner to reach applicants please indicate where you saw the position that you are applying for. Name: (Last) (First) (Middle) Position you are applying for: Date REFERRAL SOURCE INTERNET EMPLOYMENT NOTICES 1JB Wisconsin Job Service Office EMPLOYMENT NOTICES 1WL Wilenet.org IN PUBLICATIONS 1MP Moraine Park Tech College 1WB Washington County Website 1JS Journal/Sentinel online 2A West Bend Advantage 1M Monster.com 2F Action Advertiser (FDL) 1JN JobNoggin.com 2H Hartford Booster 1I Other Internet 2HE Hometown & Express Please Specify site 2K Kewaskum Statesman 2J Professional Journal (which journal?) MISC. EMPLOYMENT NOTICE 2M Madison Newspapers AREA 2OZ Ozaukee County Guide 2P Post (West Bend) 3EE Present Washington County Employee 2WB West Bend News 3HR Washington County Human Resources Dept 3JB Job Fair 3R Radio 3O Other FORM /07

5 WASHINGN COUNTY VOLUNTARY AFFIRMATIVE ACTION INFORMATION The following information is requested to help us evaluate our policy to promote equal opportunity among all who seek employment with Washington County. This information will be utilized to assess the effectiveness of our Civil Rights/Affirmative Action Plan and does not become part of your employment application. Thank you. Name: Date: (Last) (First) (Middle) Position you are applying for: Sex: Male Female RACE CATEGORY (please check one) 1. WHITE A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. 2. BLACK OR AFRICAN AMERICAN A person having origins in any of the black racial groups of Africa. Includes Haitians and other persons of African origin from the West Indies who are not Hispanic or Latino. 3. HISPANIC OR LATINO A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. 4. ASIAN OR PACIFIC ISLANDER A person having origins of Hawaii, Guam, Samoa, or other Pacific Islands, or 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. 5. AMERICAN INDIAN OR ALASKA NATIVE A person having origins in any of the original peoples of North, South or Central America, who maintains tribal affiliation or community attachment. Are you able to perform the essential functions of the job for which you are applying? YES NO If no, please explain: WASHINGN COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER