Employment Application
We consider all applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veterans status, sexual orientation, or any other legally protected status. Submit the completed application to Prowers County Department of Human Services, located at 1001 South Main Street, Lamar CO. 81052 and may be reached at (719)336-7486.
Name
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First Name
Middle Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Open position you are applying for:
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Exactly as stated on job post
Date Available to Start:
Languages you speak fluently (in addition to English):
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Employment Eligibility Questions
Are you able to complete an I-9 form verifying your employment?
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Yes
No
Are you prevented from lawfully becoming employed in the United States because or visa or immigration status?
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Yes
No
Have you ever been employed by Prowers County before?
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Yes
No
Are you capable of performing, with or without reasonable accommodation, the duties and activities involved in the job description as found on the Prowers County website? (If you have not received or reviewed a job description before completing this application, please request one from the Department of Human Services.)
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Yes
No
Pursunat to Colorado Department of Human Services personnel standards and allowable under C.R.S. 8-2-130 (4), please be aware that a criminal background check, a child abuse and neglect records check (Trails), and a passing pre-employment urinalysis (UA) drug screen are required as a mandatory condition of employment.
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Education
High School or GED
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Higher Education (College, University, or Technical School)
Additional Training, Licenses, or Professional Certifications
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Employment History
Please list your three (3) most recent employment positions, starting with your current or most recent employer. You may include military service or volunteer work relevant to the position.
Position 1 (Most Recent)
Position 2
Position 3
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Professional References
Please list three (3) professional references who are familiar with your work performance, skills, and qualificaions. DO NOT LIST RELATIVES, PERSONAL FRIENDS, OR INDIVIDUALS WHO CANNOT SPEAK TO YOUR PROFESSIONAL BACKGROUND.
Reference 1
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Reference 2
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Reference 3
*
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Additional Information
This position requires clear, accurate, and detailed documentation. Please describe and experience you have writing reports, case notes, summaries, narratives, research papers, or other professional or academic documents.
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Please describe your communication skills and experience, including any roles that required frequent interaction with clients, customers, or the public.
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Summarize special job-related skills and qualifications acquired from employment and other experiences including specialized skills.
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Please describe your level of computer proficiency, including experience with Microsoft Office, Google Programs, databases, case management systems, and your ability to learn and navigate computer programs.
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WPM:
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Please upload Resume if available.
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Application Acknowledgement and Agreement
Please read the following statements carefully before signing below. • Certification of Truthfulness: I certify that all answers and information provided in this employment application (and any accompanying resume or documentation) are true, correct, and complete to the best of my knowledge. I understand that any false, misleading, or omitted information may result in the rejection of my application or immediate termination of employment if discovered at a later date. • Reference and Documentation Verification: I authorize the Prowers County Department of Human Services to investigate all statements contained in this application and to contact my listed professional references and past employers to verify my qualifications. • Employment-at-Will Doctrine: I understand and acknowledge that, unless otherwise defined by an explicit written contact approver by the Prowers County Board of County Commissioners, any employment relationship with the Prowers County Department of Human Services is “at-will”. This means that the employee may resign at any time, and the county may terminate the employment relationship at any time, with or without cause or prior notice. • Documentation Redaction Rights: In compliance with the Colorado Job Application Fairness Act (JAFA), I acknowledge that I am not required to disclose my age, date or birth, or graduation dates on this initial application. If I have chosen to attach transcripts or certifications, I recognize my legal right to redact (black out) age-identifying information.
Signature
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Date
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Month
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Day
Year
Date
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