Application For Employment

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

Positions Appling For*
Personal Data
Education

School 1

School 2

School 3

Employment History

Please give accurate, complete full-time and part-time employment record.
Start with present or most recent employer.

Employer 1

To

Employer 2

To

Employer 3

To

Employer 4

To

Comments:

References

List three Personal or Professional References. (Do not include family members)

Reference 1*

Reference 2*

Reference 3*

Military

Describe any job-related training received in the United States military

Skills & Qualifications

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

Professional Or Civic Organization Membership
Professional Or Civic Organization Membership

List professional, trade, business or civic activities and office held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status

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.

Affirmative Action Survey

The following information is needed to complete various government reports and to implement the Affirmative Action programs to ensure elimination of discrimination on the basis of age, race, religion, color, disability or association with a person with a disability, sex, national origin or ancestry, arrest record or conviction record, sexual orientation, marital status or pregnancy, political belief, or affiliation, military participation, or use or nonuse of lawful products during non-working hours. The information furnished on this form will not and legally cannot be used adversely against an applicant for employment, except that age, sex, physical or mental ability, and conviction record may be considered when relevant to the position for which you are applying.

This document will not be kept with the employment application. It will be maintained in the confidential records of the Affirmative Action Officer.

Please note that this information is provided on a voluntary basis. If you object to furnishing the information, simply sign and date the form. Any false information on this form will be treated the same as false statements on the application form.

AN INDIVIDUAL IS CONSIDERED DISABLED UNDER THE AMERICANS WITH DISABILITY ACT IF HE/SHE:

  1. has a physical or mental impairment which substantially limits one or more major life activities
  2. has a record of such impairments
  3. is regarded as having such impairment
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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.

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".