Riverside Regional Jail Employment Application

REFERENCES
PLEASE LIST THREE (3) PROFESSIONAL REFERENCES.
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
DISCLAIMER AND SIGNATURE
My signature below gives authority to request any school or institution of learning, creditor, past or present employer or law enforcement agency to release information contained in their records to the proper official presenting this authorization for use in conducting research specifically relating to my suitability as an employee of Riverside Regional Jail.

I hereby certify that all entries on this application including any attachments are true and complete, and I agree and fully understand that any falsification of information herein, regardless of time and discovery, may cause forfeiture on my part to any employment with the Riverside Regional Jail. I understand that information on this application is subject to verification and I consent to references, former employers, and educational institutions listed being contacted, and criminal history, credit, and DMV check being conducted regarding this application.
BY SIGNING BELOW, I certify that I have read and agree with these statements.

Clear
Date*

MonthDayYear
Date

AUTHORITY FOR RELEASE OF INFORMATION
I hereby authorize any duly accredited representative of the Riverside Regional Jail bearing this release or a copy thereof, to obtain any information from schools, residential management agents, employers, criminal justice agencies, credit references, or individuals relating to my activities. The information may include, but is not limited to, academic, disciplinary, and conviction records. I hereby direct you to release such information upon request of the bearer. I understand that the information released is for official use of the Riverside Regional Jail and may be disclosed to such third parties as necessary in the fulfillment of official responsibilities.

I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind of nature which; may at any time result to me on account of compliance, or any attempts to comply with this authorization.
Authority for Release of Information Agreement*

I have read and agree with the release of information authorization
Authority for Release of Information Signature

Clear
Authority for Release of Information Date

MonthDayYear
Date

Equal Employment Opportunity (EEO) Reporting Information

This information will be used to comply with State and Federal Equal Employment Opportunity Laws and related reporting requirements. This information will NOT be kept with your application for employment and will NOT be used for making employment decisions. Federal law prohibits unlawful discrimination on the basis of race, sex, age, national origin, religion, or disability.
Position Applying For
Name*

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone Number
Work Phone Number
Cellular Phone Number
Sex
Racial or Ethnic Group
Highest Level of Completed Education
Applicable Military Experience
Do you have a documented disability?
What is the nature of your disability?
Should be Empty: