APPLICATION FOR JOB CHANGE

We appreciate your interest in our organization and assure you that your application and qualifications will be given full consideration. Jefferson County is an equal opportunity employer and does not discriminate on the basis of age, race, creed, color, disability, marital status, sex, sexual orientation, religion, national origin, ancestry, arrest or conviction record, veteran status or any other basis prohibited by state or federal law.

Warning: This is an electronic application that cannot be saved. The application must be completed in its entirety in order to be successfully submitted.

Application works best with the following web browsers: Firefox, Chrome and Internet Explorer. Utilizing other browsers, including Safari, may not work with this application.

* Required Information

Employee Information

*Employee Number:

*First Name:

*Last Name:

Middle Initial:

Professional License/Registration:

Primary Phone:

Alternative Phone:

Email Address:

County Employment History

CURRENT POSITION

*Position:

*Department:

*Position From:

TO Present

Previous Position 1

Position:

Department:

Position From:

Previous Position 2

Position:

Department:

Position From:

Previous Position 3

Position:

Department:

Position From:

Previous Position 4

Position:

Department:

Position From:

Employee Education

School 1

Type of School:

High School

Name of School:

School City:

School State:

Course of Study:

Years Completed:

Diploma Received?

Yes

School 2

Type of School:

Name of School:

School City:

School State:

Course of Study:

Years Completed:

Diploma Received?

Yes

Certificate /
Diploma or
Degree Received:

School 3

Type of School:

Name of School:

School City:

School State:

Course of Study:

Years Completed:

Diploma Received?

Yes

Certificate /
Diploma or
Degree Received:

Skills & Qualifications

Describe any specialized training, apprenticeship, job-related skills and extra-curricular activities: (equipment operated, software programs, foreign languages, professional licenses, etc):

Special Note

DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the essential activities involved in the job or occupation for which you have applied? A review of the essential activities involved in such a job or occupation has been received.

Please Select Yes or No.

Yes

Certification and Agreement

I certify that the information provided by me on this application or during the interview process is true and correct without misrepresentation or omission of any kind whatsoever and I understand that if any of this information is discovered to be incorrect, false or misleading, it may result in denial of employment or discharge. I authorize the persons, employers, schools and organizations listed above to give any information to Jefferson County that they may have regarding me for the purpose of performing background checks. I hereby release those employers, schools and organizations and all individuals connected with them from all liability including any claims for damages for releasing this information to Jefferson County.

I understand that employment is contingent upon a favorable evaluation and/or results of any pre-employment requirements necessary to perform the position applied for which may include a health evaluation form, medical examination, skills testing, aptitude testing, verification of employment or other assessment determined necessary.

I understand that I have the right to receive an Equal Employment Opportunity and may file a written grievance alleging discrimination in employment and/or access to services with the Human Resources Department. If an accommodation is needed for an interview, I understand that it is my responsibility to request this in advance.

By signing this application, I understand that no contract exists between Jefferson County and me. I understand that, if I become employed, I am not guaranteed employment and may be considered an "employee-at-will" under the laws of the State of Wisconsin. I understand this application for employment shall be considered active for the period of time the position applied for is vacant or for 60 days, whichever is longer and that consideration for employment beyond this time period requires reapplication.

I have read, understand, and agree to the above.

Upload Resume & Cover Letter Valid Extension:(txt,rtf,pdf) File Size: 1 MB

Cover Letter:

Resume:

Sign & Date

Warning: Jefferson County requires that you certify your application by submitting an electronic signature. To certify your application, type your full legal name and today's date and click "Submit Application".

Name*:

Date*: