Form-1

Canadian County Children’s Justice Center

EMPLOYMENT APPLICATION (rev. 01-11)

Canadian County is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, sex, age, color, religion, political affiliation, national origin, veteran status or disability as provided in federal and state regulations. This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all information has been completed.

PERSONAL:
Date:
Name:
Home Phone:
Cell Phone:
Email Address:
Address
Social Security No.
Are you at least 18 years of age?
Yes
No
Are you a citizen of the U.S. or do you have the legal right to be employed in the United States?
Yes
No
Have you ever been convicted of any crime (excluding minor traffic violations) including driving while under the influence of alcohol or other drugs?
Yes
No
If yes, state the offense, location, date and disposition (NOTE: A conviction will not necessarily disqualify you from employment)
Do you have the ability, with or without reasonable accommodation, to work overtime or to travel if required by the job for which you are applying?
Yes
No
If no, please explain
Driver’s License:
State:
Number
Type
Currently Valid?
Yes
No
Do you authorize CCCJC to obtain a copy of your driving record?
Yes
No
Are you willing to submit to a drug test in accordance with facility policy?
Yes
No
Do you authorize CCCJC to obtain a criminal background check?
Yes
No
Have you or any of your immediate family received any type of services from Canadian County Children’s Justice Center?
Yes
No
If yes, when were services completed or terminated?
List relatives employed by CCCJC and their relationship to you
EMPLOYMENT DESIRED:
Full-time
Part-time
temporary or summer employment
(check all that apply)
Position for which you are applying
Salary Desired
Date available to start
Have you ever applied for employment with this county before?
Yes
No