CAPABILITY I RELIABILITY (Cont’d):
If you are currently employed, may we contact your company?
Yes
No
Have you ever been fired or asked to resign from a job?
Yes
No
If yes, please explain
Will you abide by the safety rules of this agency?
Yes
No
Have you ever been disciplined for violating an employer’s safety rules or regulations?
Yes
No
If yes, please explain
How many days of work or school have you missed in the last two years?
How many times have you been late for work or school in the last two years?
Have you ever been disciplined or received verbal or written warnings for absenteeism or tardiness?
Yes
No
If yes, please explain
Are you willing and able to report to work on time every day on a regular and consistent basis?
Yes
No
If no, please explain
Please use the space below to describe why you are interested in working for our agency and list the skills and abilities that
you feel particularly qualify you for a position with us. If you need more space, please continue on a separate sheet.
Please use the space below to describe why you are interested in working for our agency and list the skills and abilities that
you feel particularly qualify you for a position with us. If you need more space, please continue on a separate sheet.
Are you at least 21 years of age or older?
Yes
No
Are you willing and able to perform all of the tasks required by the job for which you are applying (including
physically restraining juveniles if it is part of your job description)?
Yes
No
Are there any days or hours you are unable or unwilling to work?
Yes
No
yes, please specify
the days and/or the hours you are unable or unwilling to work
