2025 Summer Work Program - Application Packet

JEFFERSON COUNTYHUMAN RESOURCES

66 SE D St, Suite E Madras, OR 97741 Ph (541) 325-5002 Fax (541) 325-4454 HR@jeffersoncountyor.gov
The Summer Work Program employs those who are graduating this year (2025) from a Jefferson County High School or a Jefferson County High School graduate who (or whose parent(s)/guardian) resides in Jefferson County is currently attending and expects to continue to attend college, university and/or post High School vocational training on a full-time basis during the school year of 2025-2026. The Summer Work Program duties are to perform general labor or clerical tasks to assist any of the following divisions of Jefferson County Government: Buildings & Grounds (includes parks and cemetery), Public Works, Administration, or the Jefferson County Fairgrounds.

Program Specifications:
- Applicants must be 18 years of age or older.
- The start date of the Summer Work Program will be no later than June 16, 2025.
- The maximum duration of Summer Work employment will be 90 calendar days.
- A Summer Work participant's schedule may include an alternative workweek, such as Tuesday-Saturday or Sunday-Thursday.
- Time off during the Summer Work Program must be pre-arranged and approved by the Supervisor.
- Time off during the Summer Work Program cannot exceed five (5) consecutive workdays or 40 total hours.
- Summer Work participants are held to the same standards of conduct as any Jefferson County Employee.
- Jefferson County reserves the right to terminate the employment relationship at any time with or without cause.
- The 2025 Summer Work participants hourly wage is $18.65 for the first year of employment. If the Summer Work participant is selected to return for succeeding years (2nd, 3rd and 4th) their hourly wage will increase by 2% from the summer program wage.
- Summer Work participants who have questions or concerns regarding work and other matters, may communicate them to their Supervisor, the Department's Director or the Human Resources Department, HR@jeffersoncountyor.gov.
- Participation in the Summer Work Program is limited to five (5) years.
- Jefferson County will conduct a background check which must be successfully passed to be considered for the 2025 Summer Work Program. Jefferson County is committed to a drug-free environment and applicants may be subject to a pre-employment drug screening.
The application and job packet can be obtained by visiting Mid Oregon Personnel at 213 SW 4th Street, Madras, OR. 97741; by calling (541) 475-7640; or by visiting https://www.midoregonpersonnel.com/madras-office/

To apply, you must complete and submit via Mid Oregon website, mail, fax, email or hand deliver all documents which are part of the application packet: (1) employment application; (2) letter of interest; (3) supplemental information; (4) a current unofficial transcript; (5) proof of current classes; and (6) proof of Fall 2025 school enrollment (A letter of acceptance, or letter of intent to attend the educational institution will be accepted in lieu of proof of enrollment) to: Jefferson County Mid Oregon Personnel 213 SW 4th Street, Madras, OR 97741 Fax: 541-475-7656

Email address: Julie@midoregonpersonnel.com https://www.midoregonpersonnel.com/madras-office/ by 5:00 pm on Monday, May 5, 2025 (If documents are faxed, you must also mail the original application packet to the address above If the applicant can't provide the required documents, they must submit a letter in writing explaining their reasons why. Incomplete application packets will not be considered.

Jefferson County is an Equal Opportunity Employer.
Jefferson County Summer Work Program Letter of Interest
I, (enter your name below), would like to participate in the Summer Work Program for 2025.*

First NameLast Name
The start date of the Summer Work Program will be no later than June 16, 2025. The maximum duration of Summer Work employment will be 90 calendar days. Any time off during the Summer Work Program must be pre-arranged and approved by the Supervisor. Any time off during the Summer Work Program cannot exceed five (5) consecutive workdays, 40 total hours. The dates leading up to and including annual County Fair will not be granted "time-off"

requests. I will be held to the same standards of conduct as any Jefferson County employee. ASummer Work participant's work schedule may include an alternative workweek, such as Tuesday- Saturday or Sunday-Thursday. Jefferson County reserves the right to terminate the employment relationship at any time with or without

A 2025 Summer Work participant's hourly wage is $18.65 for the first year of employment. If a Summer Work participant is returning for succeeding years (2nd, 3rd and 4th) their hourly wage will increase by 2% for each year. If I have questions or concerns regarding work and other matters, I may communicate them to my Supervisor, Department Director or the Human Resources Department, HR@jeffersoncountyor.gov. Participation in the Summer Work Program is limited to five (5) years. I understand that Jefferson County will conduct a criminal background check which I must successfully pass. I must complete and submit the release forms SO I may be considered for the 2025 Summer Work Program. To be considered, I must complete and submit via Mid Oregon/Madras website, mail, fax or hand deliver all documents which are part of the application packet: (1) employment application; (2) letter of interest; (3) supplemental information; (4) a current unofficial transcript (5) proof of current classes; and (6) proof of Fall 2025 school enrollment (A letter of acceptance, or letter of intent to attend the educational institution will be accepted in lieu of proof of enrollment) to:

Jefferson County Mid Oregon Personnel 213 SW 4th Street, Madras, OR 97741 https://www.midoregonpersonnel.com/madras-office/ Fax: 541-475-7656 Email address: julie@midoregonpersonnel.com by 5:00 pm on Monday, May 5, 2025 (If documents are faxed, you must also mail the original application packet to the address above If the applicant can't provide the required documents, they must submit a letter in writing explaining their reasons why. Incomplete application packets will not be considered.

Incomplete packets will not be considered.
Applicants Signature*

Clear
Date*

MonthDayYear
Date
Jefferson County is an Equal Opportunity Employer.
Jefferson County Summer Work Program Supplemental Information
Note: Falsification of any information will be grounds for dismissal from the program.
I, (enter your name below), wish to participate in the 2025 Jefferson County Summer Work Program.*

First NameLast Name
I can start on: (no later than 6/16/2025)*

MonthDayYear
Date
I am attending or plan to attend: (Enter name of High School University or College Institution)*
Located at City and State*
I can be reached at:
Enter Mailing address:*
Please indicate who the mailing address is for:*
Enter Phone Number*
Please indicate who the phone number is for:*
Enter Text Phone Number*
Please enter a valid phone number.
Please indicate who the text message phone number is for:*
Enter Email*
example@example.com
Please indicate who *
Print Name*
Signature*

Clear
Date*

MonthDayYear
Date
Jefferson County is an Equal Opportunity Employer.
APPLICATION FOR EMPLOYMENT

PLEASE FILL OUT APPLICATION COMPLETELY. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. FILL OUT ALL FIELDS AND DO NOT WRITE "SEE RESUME."

Applicant Information
Date*

MonthDayYear
Date
Name*

First & Middle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
Phone Number*

Military Service
Military Service: Date Entered (If applicable)
Military Service: Date Separated (If applicable)
Military Service: Honorable Discharge? (If applicable)

YesNo
Military Service: Rank (If applicable)
Military Service: Branch (If applicable)
Military Service: Occupation (If applicable)

High School Education
What is the highest grade/year completed in school?*
Name of high school *
Location of high school*
Did you graduate high school?*

YesNoGED
Year diploma was/would have been granted*

School Attended after High School #1
Name/Location & Dates From/To
Full-time or Part-time
Field of study (Major & Minor)
Hours completed (Semester)
Hours completed (Quarter)
Did you graduate?
Certificate or degree earned
Full-time or Part-time
Field of study (Major & Minor)

Hours completed (Semester)
Hours completed (Quarter)
Did you graduate?
Certificate or degree earned

Professional References
Professional Work Reference #1 - Name*
Professional Work Reference #1 - Phone number*
Professional Work Reference #1 - Email
Professional Work Reference #2 - Name*
Professional Work Reference #2 - Phone number*
Professional Work Reference #2 - Email
Professional Work Reference #3 - Name*
Professional Work Reference #3 - Phone number*
Professional Work Reference #3 - Email
Please provide the last four digits of your Social Security Number:*
Will you be able to provide proof of Citizenship or an alien registration number and visa permitting work in this country if hired?*

YesNo
By this application and my signature, I authorize you to check the validity of my social security number and other pertinent identification. Please INITIAL.*

Employment Desired
1st Position desired *
2nd Position desired
3rd Position desired
Are you seeking regular (full-time) employment?*

YesNo
Are you seeking Part-time employment?*

YesNo
If seeking temporary employment, when would you expect to terminate?
Date you can start*

MonthDayYear
Date
Salary or wage desired*
Are you willing to accept odd (nights, graveyard or weekend) or rotating shifts?*

YesNo
Have you ever applied to this company before?*

YesNo
If yes, when and where?
What is the most amount of weight that you're able to lift or carry for prolonged periods?*
What you have done in the recent past to demonstrate that you can lift or carry the amount of weight entered above?*
How many days did you miss from work this past year?*

Employment History

Please list, starting with your most recent employer.

Most recent job
Name, Address, and Phone of Company*
Employed From AND To (Month & Year)*
Primary Duties Performed*
Immediate Supervisor & Reason for leaving*

Job #2
Name, Address, and Phone of Company (Enter N/A if not applicable)*
Employed From AND To (Month & Year) (Enter N/A if not applicable)*
Primary Duties Performed (Enter N/A if not applicable)*
Immediate Supervisor & Reason for leaving (Enter N/A if not applicable)*

Job #3
Employed From AND To (Month & Year)
Immediate Supervisor & Reason for leaving

Explanation of Special Skills
Please include any special skills (Enter N/A if not applicable)*

Emergency Contact & Authorization
Emergency Contact (Name, Relationship, Phone Number)*
I HEREBY AUTHORIZE YOU TO CONSULT AND OBTAIN INFORMATION FROM ANY EMPLOYER I AM WORKINGOR HAVE WORKED FOR:*

YesNo
Authorization

I authorize the investigation of all matters which PSI deems relevant to my qualifications for employment, including all statements made in this application and in any attachments or supporting documents. I authorize PSI to request, receive and share with any agent or client employer such information and I release from all liability any persons, such as but not limited to, supervisors or employers supplying it. I also release PSI and any of its agents or client employers from all liability which might result from making the investigations. If employed, I understand that misrepresentation or omission of facts called for is cause for dismissal. If offered employment, I am also willing to take a physical examination and authorize the doctor or doctors involved to disclose to the prospective employer here and any of its agents or client employers the results of that examination. I agree to comply with the employer's substance abuse program, including drug testing as may be required. If employed, I agree to conform to the rules of this company, and hereby acknowledge that my employment with the company can be terminated at any time, with or without cause, at the option of either myself or the company. I further understand and acknowledge that nothing contained in any employee handbook or policy statement nullifies or modifies the foregoing employment at will policy.
Today's Date*

MonthDayYear
Date
Signature

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Required additional documents
1. A current unofficial transcript*

Cancelof
2. Proof of current classes*

Cancelof
3. Proof of Fall 2025 school enrollment (A letter of acceptance, or letter of intent to attend the educational institution will be accepted in lieu of proof of enrollment) to.*

Cancelof
Should be Empty:

JEFFERSON COUNTYHUMAN RESOURCES

Jefferson County Summer Work Program Letter of Interest

Jefferson County Summer Work Program Supplemental Information

I can be reached at:

APPLICATION FOR EMPLOYMENT

Employment History

Authorization

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