ADAMS COUNTY APPLICATION FOR EMPLOYMENT
Please complete all requested information. Incomplete applications will be disqualified.

* Required Fields

Date:	3/12/2010
	Please select position below: *
Position applying for:	Please Select a Job

REFERRAL INFORMATION
Referal Source: (Please check one)
	Newspapers (printed classified ads) Newspapers (posted on their respective websites) Job Service Centers (Workforce and Business Centers) Adams County Employee Adams County Job Line Adams County Website County Facility Other Recruiting Websites
	If Other Recruiting Websites, please list::

PERSONAL INFORMATION
First Name:	*
Middle Initial:
Last Name:	*
Address:	*
City:	*
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana 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 Pennsyvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:	xxxxx-xxxx *
Phone:	(xxx) xxx-xxxx *
Email Address:

GENERAL INFORMATION
List any previous employment with Adams County:
	Department or Office:
	Dates:
List names of any relatives currently working for Adams County:
	Relationship:
	Department or Office:
Have you ever been charged with a felony or misdemeanor crime for which you have entered into a plea agreement, pled guilty, pled no contest, or been convicted?		YesNo *
	Your response to this question does not necessarily disqualify you as an applicant for employment.
	If yes, please explain:
Are you currently employed?	YesNo *
	If so, may we contact your present employer?	YesNo
Answer the following only if you are applying for a position which requires a valid Colorado Driver's License.
Do you have a valid Colorado Driver's License?	YesNo
	If yes, what type:
In the last three years, have you been convicted of any traffic violations?		YesNo
	If yes, please explain:
Answer the following only if you are applying for a commissioned position with the Sheriff's Office. (In order to be considered for a commissioned position you must be a minimum of 21 years of age and be a post certified Peace Officer in the State of Colorado.)
Are you twenty-one years of age or older?	YesNo

EDUCATION
HIGH SCHOOL/GED
Name of School:	*
Location:	*
Course of Study:	*
Degree Received:	*
# of Years Attended:
VOCATIONAL/TRADE
Name of School:
Location:
Course of Study:
Degree Received:
# of Years Attended:
COLLEGE UNIVERSITY
Name of School:
Location:
Course of Study:
Degree Received:
# of Years Attended:
COLLEGE UNIVERSITY
Name of School:
Location:
Course of Study:
Degree Received:
# of Years Attended:
Have you worked or attended school under any other name?	YesNo *
	If so, list the name or names used:

PROFESSIONAL LICENSE/REGISTRATION/CERTIFICATIONS
Profession or Trade:
Number:
Issued By:
Expires:	(MM/DD/YYYY)

EMPLOYMENT HISTORY
LIST MOST CURRENT EMPLOYMENT FIRST AND COMPLETE ALL OF THE BLANKS. INCOMPLETE APPLICATIONS MAY BE DISQUALIFIED.
1.
Position Title:
Name of Employer:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana 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 Pennsyvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:	xxxxx-xxxx
Phone:	(xxx) xxx-xxxx
Supervisor:
Dates of Employment:	From: To: (MM/DD/YYYY)
Duties:
Reason for Leaving:
May we contact this employer?	YesNo
Beginning Salary:
Ending Salary:
2.
Position Title:
Name of Employer:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana 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 Pennsyvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:	xxxxx-xxxx
Phone:	(xxx) xxx-xxxx
Supervisor:
Dates of Employment:	From: To: (MM/DD/YYYY)
Duties:
Reason for Leaving:
May we contact this employer?	YesNo
Beginning Salary:
Ending Salary:
3.
Position Title:
Name of Employer:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana 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 Pennsyvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Phone:
Supervisor:
Dates of Employment:	From: To: (MM/DD/YYYY)
Duties:
Reason for Leaving:
May we contact this employer?	YesNo
Beginning Salary:
Ending Salary:
4.
Position Title:
Name of Employer:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana 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 Pennsyvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Phone:
Supervisor:
Dates of Employment:	From: To: (MM/DD/YYYY)
Duties:
Reason for Leaving:
May we contact this employer?	YesNo
Beginning Salary:
Ending Salary:

PROFESSIONAL REFERENCES
Please list up to 3 professional references.
1
Name:
Job Title:
Address:
Phone:	(xxx) xxx-xxxx
2
Name:
Job Title:
Address:
Phone:	(xxx) xxx-xxxx
3
Name:
Job Title:
Address:
Phone:	(xxx) xxx-xxxx

ADDITIONAL INFORMATION

Please summarize special job-related skills/qualifications acquired from employment or other experience that are related to the position for which you applied. Include any information you feel may be helpful in considering your application.

RESUME

Please cut and paste a copy of your resume into the box below.

AGREEMENT INFORMATION

I certify that the information in this application is true and complete. I understand that any falsification or significant omission of information in this application may result in refusal of employment or immediate discharge from employment. I authorize the investigation of any or all statements contained in this application, including criminal history, and also release any person, school, current employer, past employers and organizations from any legal liability in making such statement. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time. If employed, I understand I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause and with or without notice.