City of Jennings Corrections Job Application

City of Jennings Corrections Job Application

City of Jennings Corrections Job Application

The City of Jennings, MO resolves that subject to all applicable State and Federal statutory or judicial exceptions, all qualified applicants for employment shall be given equal opportunity for consideration, selection, appointment, and retention regardless of race, color, religion, sex, national origin, age, disability, or political affiliations. APPLICANT PERSONAL HISTORY QUESTIONNAIRE(Confidential Information/ Restricted Access) VERIFICATION OF INFORMATION The information requested in this questionnaire will be used for reference by those who will be considering your application for employment with the Jennings Department of Corrections. An extensive background will be conducted into your personal history. Supplying any FALSE. MISLEADING, or INCOMPLETE information will be grounds to disqualify you from further consideration in the application process with the Jennings Corrections Department and if the FALSE, MISLEADING, or INCOMPLETE information is discovered after appointment. It may be grounds for termination of your employment with the City of Jennings, Missouri. I confirm that I have read and that I understand the above and that all statements and documents presented to the Jennings Department of Corrections are true, correct, complete, and made in good faith.
Personal Information
Full Name

First NameMiddle NameLast Name
Position Applied For
Home Street Address
City, State, ZIP Code
Home Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Date of Birth

MonthDayYear
Date
Racial/Ethnic Group

Other
How did you learn of this job opening?

Other
Are you legally authorized to work in the United States?
If not authorized, do you have a valid work permit?
Have you ever had your name legally changed?
Previous Name(s)
Date of Name Change

MonthDayYear
Date
Reason for Name Change
Have you ever used any other name?
All Other Names Used
Residence History (last 10 years)
Work History
Most Recent Employer - From Date

MonthDayYear
Date
Most Recent Employer - To Date

MonthDayYear
Date
Employer Name
Employer Address
Employer Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Duties Performed
Supervisor Name
Co-Worker Name
Reason for Leaving
Additional Work History (2–4 previous jobs)
Have you ever been discharged or forced to resign due to misconduct or unsatisfactory service?
Explanation of discharge/forced resignation
Military Service
Have you ever served in the U.S. Armed Forces?
Military Service – Dates From

MonthDayYear
Date
Military Service – Dates To

MonthDayYear
Date
Branch of Service
Unit Designation
Current/Highest Rank Held
Type of Discharge
Were you disciplined while in military service?
Military Discipline Details
Education
High School Name
High School City and State
High School Dates Attended From

MonthDayYear
Date
High School Dates Attended To

MonthDayYear
Date
Did you graduate from high school?
College/University 1 – Name
College/University 1 – City and State
College/University 1 – Dates From

MonthDayYear
Date
College/University 1 – Dates To

MonthDayYear
Date
College/University 1 – Degree Received
College/University 1 – Date of Degree

MonthDayYear
Date
College/University 2 – Name
College/University 2 – City and State
College/University 2 – Dates From

MonthDayYear
Date
College/University 2 – Dates To

MonthDayYear
Date
College/University 2 – Degree Received
College/University 2 – Date of Degree

MonthDayYear
Date
Trade/Vocational/Business School(s) – Details
POST Certification / Academy Training Details
Special Licenses Held
Special Skills (languages, computer, etc.)
Background Information
Have you ever been arrested for, convicted of, or pled guilty to a felony offense?
Felony Offense Details
References
Reference 1 – Name
Reference 1 – Relationship
Reference 1 – Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 – Email
example@example.com
Reference 2 – Name
Reference 2 – Relationship
Reference 2 – Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 – Email
example@example.com
Reference 3 – Name
Reference 3 – Relationship
Reference 3 – Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3 – Email
example@example.com
Document Checklist
Resume

Cancelof
Certificates, Licenses, High School Diploma, and College Degree

Cancelof
Drivers License

Cancelof
Acknowledgment and Authorization
Initials
Applicant Signature
Date Signed

MonthDayYear
Date
Should be Empty: