COUNTY OF ALBEMARLE Department of Human Resources Albemarle County Office Building 401 McIntire Road Charlottesville, VA

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1 COUNTY OF ALBEMARLE Department of Human Resources Albemarle County Office Building 401 McIntire Road Charlottesville, VA Dear Candidate: Thank you for your interest in a position with Albemarle County. Your application will remain in our active files for one year. If you are interested in any additional positions that become available, please contact the Department of Human Resources and request that your application be submitted for that position. To have a file activated, the following must be submitted to the Human Resources Department: 1) a completed and signed application 2) a completed EEO form (top portion only is required) 3) copies of college transcripts (if applicable) Included with this letter is a description of Albemarle County s classified application and selection process. Should you have any questions, please feel free to call our office at (804) Good luck in your search for a position! Sincerely, Mitsuko Clemmons-Nazeer Recruitment/Selection Coordinator

2 EQUAL EMPLOYMENT OPPORTUNITY/AFFIRMATIVE ACTION APPLICANT INFORMATION FORM Dear Applicant: Information required on this form will be used solely for purposes of reporting and evaluating Albemarle County s progress in its equal employment and affirmative action practices. By law, this information CANNOT and WILL NOT be used in a discriminatory manner in determining employability, evaluation of performance, or employment promotion. Completion of the TOP PORTION of this form is REQUIRED. Completion of the BOTTOM PORTION of this form is OPTIONAL. Please return to the Human Resources secretary. Thank you! NAME: LAST FIRST MI PHONE: ADDRESS: # STREET CITY STATE ZIP CODE SOCIAL SECURITY NUMBER: - - TODAYS DATE: / / POSITION APPLIED FOR: HOW DID YOU LEARN OF THIS VACANCY? (please circle one) 01 = Mail 02 = College Placement Office (please give name of college) 03 = Job Service 04 = County Employee 05 = Newspaper Ad (please give name of paper) 06 = Community Organization (please give name of organization): 07 = State Office 08 = College Recruitment Fair (please give name of college/university): 09 = Walk In 10 = Other (please specify): (OPTIONAL) SEX (please circle one) ETHNIC GROUP (please circle one) AGE (please circle one) M = Male 5 = White 4 = Black 1 = = F = Female 3 = Hispanic 2 = Asian/Pacific Islander 3 = = 56 or older 1 = American Indian/Alaskan Native VETERAN (please circle one) DISABILITY STATUS (please circle one) 1 = Non Vet 0 = No disability 2 = Vietnam 1 = Physical 3 = Other 2 = Visual 3 = Hearing 4 = Intellectual 5 = Emotional/Psychological

3 ALBEMARLE COUNTY CLASSIFIED APPLICATION AND SELECTION PROCESS THANK YOU Thank you for your interest in Albemarle County. WHAT HAPPENS NEXT Your application will be reviewed and placed in our ACTIVE FILES for consideration. It is your responsibility to have all the required supporting documents sent to the Human Resources Department. WHEN A VACANCY OCCURS After the position announcement closing date, your application will be reviewed by the Human Resources Department to determine if you meet the criteria asked for by the selecting Department Head/Principal. If your credentials have met the qualifications for the position, your application will be sent to the Department/School for review. INTERVIEW The Department Head/Principal determines which candidate will be interviewed. After this determination, the Department/School will be in contact with those of you who are scheduled for an interview. NOTIFICATION OF EMPLOYMENT The official notification of employment comes from the Human Resources Department. If selected for a position, you will be informed by the Human Resources Department of your starting date and the terms and conditions of employment. You will be asked to come to the Human Resources Department to enroll in the benefits program. APPLICATION RENEWAL Your main application will remain in the ACTIVE FILES for one year from the date of receipt. It will be retained as INACTIVE for two additional years unless an application renewal is requested. Your application will be returned to the ACTIVE FILES only upon receipt of the renewal request. For each additional position you are interested in, you will need to call the Human Resources Department and ask that your application be considered for the position. A FINAL NOTE You are encouraged to keep the Human Resources Department informed of changes which occur in the information submitted in your original application. If you have questions concerning the selection process, you are encouraged to call the Human Resources Department. EQUAL OPPORTUNITY EMPLOYER

4 NOTICE TO APPLICANTS Albemarle County is committed to having an alcohol/drug free workplace. Candidates for certain safety related positions will, as a condition of employment, be required to have a test for illegal substances. Positive results on this pre-employment test will result in the denial of employment with the County. A copy of the County s policy as well as the list of designated safety related positions is available upon request in the Human Resources Department. Questions about this policy may be addressed to the Director of Human Resources, 401 McIntire Road, Charlottesville, VA EQUAL OPPORTUNITY EMPLOYER

5 COUNTY OF ALBEMARLE An Equal Opportunity Employer APPLICATION FOR CLASSIFIED EMPLOYMENT PERSONAL: Date: Full Legal Name: (Last Name, First Name, Middle Initial) Social Security Number Present Address _ No. Street How many years at this address? Telephone No.: Area Code ( ) Daytime No.: Area Code ( ) Job(s) applied for: 1. Rate of Pay Expected per 2. Rate of Pay Expected per How did you learn of this opening? I am available to work: Full-Time! Part-Time! On Shifts! Seasonal! If hired, on what date will you be available to work? Have you ever been convicted of any offenses other than minor traffic violations, e.g. speeding? Yes No If yes, describe in full (Note: A conviction does not automatically mean you will not be hired. The type and date of the conviction are important. Please give all facts so that a decision can be made.) Have you ever been employed here before? Yes! No! When? Have you ever served in the armed forces? Yes! No! If yes, describe training and duties. Did you receive an Honorable Discharge? Yes! No! Typing Speed: Experience with Computers/Word Processing (List type of equipment) Driver s License: Driver s License #: State Issued: Expiration Date:

6 EMPLOYMENT EXPERIENCE List each job held. Start with your present or most recent job. Include military service assignments and volunteer activities. YOUR APPLICATION WILL NOT BE CONSIDERED UNLESS YOU PROVIDE ALL INFORMATION REQUESTED BELOW. STATING SEE RESUME WILL MAKE YOUR APPLICATION INVALID. Employer From DATES To WORK PERFORMED Address Starting SALARY Final Job Title Telephone Number Reason for Leaving Supervisor Hr Hr Wk Wk Mo Mo Full-time! Part-Time! Hours Per Week Employer From DATES To WORK PERFORMED Address Starting SALARY Final Job Title Telephone Number Reason for Leaving Supervisor Hr Hr Wk Wk Mo Mo Full-time! Part-Time! Hours Per Week Employer From DATES To WORK PERFORMED Address Starting SALARY Final Job Title Telephone Number Reason for Leaving Supervisor Hr Hr Wk Wk Mo Mo Full-time! Part-Time! Hours Per Week Employer From DATES To WORK PERFORMED Address Starting SALARY Final Job Title Telephone Number Reason for Leaving Supervisor Hr Hr Wk Wk Mo Mo Full-time! Part-Time! Hours Per Week

7 If you need additional space, please continue on a separate sheet of paper. Elementary High G.E.D. College/University Graduate/Professional School Name Grade/Number of Years Completed: (Circle) Diploma/Degree Describe specialized training, apprenticeship, skills or selected extra curricular activities. LIST THREE PEOPLE WHO WOULD HAVE KNOWLEDGE OF YOUR QUALIFICATION. PLEASE DO NOT INCLUDE RELATIVES. Name Address Telephone Number Occupation ( ) ( ) ( ) Occasionally an application makes it difficult for an individual to adequately summarize his/her complete background. To assist us in finding the proper position for you in the County, please use the space provided below to summarize any additional information or job-related skills acquired from employment necessary to describe your full qualifications.

8 For purposes of compliance with Section of the Code of Virginia, entitled Employment of Illegal Immigrants, please state whether you are legally eligible for employment in the United States: Yes! No! (You are legally eligible for employment if you are a United States citizen or if you have an appropriate permit to work in the United States through the Department of Justice or the United States Department of Labor.) CRIMINAL INVESTIGATION NOTICE TO APPLICANTS It is the policy of Albemarle County to request criminal and driving records (for certain positions) on applicants during the screening process. Applicants with criminal or traffic convictions may be rejected for employment where there is a demonstrable relationship to the job for which the applicant is applying. Albemarle County will consider the nature, gravity, and time of the offense rather than automatically excluding applicants solely on the basis of a conviction. Arrest records will have no bearing on the selection process; however, an applicant may be required to provide additional information before being allowed to continue in the selection process. If, when requested, you do not sign the Criminal History or Motor Violation Record Request form, you will not be considered for employment. For applicants for positions in Albemarle County Public Schools: Applicants for positions in Albemarle County Public Schools will be required to submit fingerprints for an FBI criminal history records check. In addition, school division employees will be required to complete a Child Protective Services Release of Information Form. Have you ever been convicted of any felony, any crime involving moral turpitude, or any offense involving the sexual molestation, physical or sexual abuse or rape of a child? YES NO If yes, describe in full. Have you ever been the subject of a founded case of child abuse or neglect? YES NO If yes, describe in full. VERIFICATION OF ELIGIBILITY TO WORK Albemarle County adheres to the Immigration Reform and Control Act of 1986 which requires new employees to present documentation of citizenship or the authorization to work in the United States. If you are employed by the County, you will have to present, within three days of the employment date, a social security card or U.S. birth certificate plus a driver s license or other photo identification, i.e. sate, federal or military I.D. AGREEMENT I certify that answers given herein are true and complete to the best of my knowledge. I authorize you to make such investigation and inquiries to my personal references, previous employers, and other legally related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools or other persons from all liability in responding to inquiries in connection with my application. In the event of employment, I understand that false or misleading information given on my application form(s) or interview(s) may result in discharge. I understand also that I am required to abide by all rules and regulations of the County. Signature of Applicant (in ink) Albemarle County does not discriminate on the basis of race, color, national origin, gender, religion, age or disability in employment. Revised: 11/99