Application for Employment

Application for Employment

Stutsman County is an Equal Opportunity Employer

We consider applications for all positions without regard to race, gender, creed, religion, sexual orientation, national or ethnic origin or any other legally protected status.

Complete the entire application. If you fail to complete all questions your application will be deemed incomplete and may be rejected. On the last page of this form there will be an option to upload additional documents such as cover letters, resumes, DD-214 forms, etc.

Date*

Select Date ×

Position Applying For:*

Full Name*

First Middle Last

Address*

Street

City

State

ZIP

SSN*

Phone (Home)

Phone (Work)

Phone (Mobile)

Email Address*

Email Address

Best time to contact you?*

How do you prefer we contact you?*

Phone (Home)

Phone (Work)

Phone (Mobile)

E-mail

Are you eligibile to work in the US?*

Can you travel if the job requires it?*

If required, do you have a valid driver's license?*

If you do have a valid driver's license, list State of issuance, license number and expiration date.

Are you 18 years of age or older?*

If under 18, what is your current age?

Are you currently employed by Stutsman County?*

If currently employed, what is your current job title?

Have you ever been employed by Stutsman County?*

If you have been previously employed, list dates of employment and reason for leaving.

Are you related to any current Stutsman County employee?*

If you are related to a current employee, list their name and relationship.

How did you learn about this employment opportunity?*

If selected, what date are you available to start work?*

What is your desired salary range (monthly)?*

Are you available to work:*

Part-Time

Full-Time

What shifts are you available?*

Morning

Afternoon

Evening/Nights

Education

Name Of School:*

Address*

City

State

Course Of Study:*

Degree Received:*

Major:*

Name Of School:

Address

City

State

Course Of Study:

Degree Received:

Major:

Name Of School:

Address

City

State

Course Of Study:

Degree Received:

Major:

Skills, Credentials & Licenses

List credentials, licenses, professional affiliations, etc. which are relevant to the job for which you are applying.*

Write Here

List technical skills, clerical skills, trade skills, etc. relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge and note your level of proficiency (basic, intermediate, expert, etc.)*

Write Here

State any additional information you feel may be helpful to us in considering your application.

Write Here

Work Experience

Please detail your work history. Begin with your current or most recent employer. Please explain any gaps in employment. Include full-time military or volunteer commitments. DO NOT complete this information with the notation “See Resume.”

May we contact your current employer?*

Stutsman County reserves the right to contact all current and former employers for reference information.

Employer Name*

Address*

Street

City

State

ZIP

Phone Number*

Phone (Employer)

Your Job Title*

Supervisor/Manager*

Dates Employed*

Starting Hourly Rate/Salary*

Ending Hourly Rate/Salary*

Work Performed*

Write Here

Reason For Leaving*

Write Here

Employer Name*

Address*

Street

City

State

ZIP

Phone Number*

Phone (Employer)

Your Job Title*

Supervisor/Manager*

Dates Employed*

Starting Hourly Rate/Salary*

Ending Hourly Rate/Salary*

Work Performed*

Write Here

Reason For Leaving*

Write Here

Employer Name*

Address*

Street

City

State

ZIP

Phone Number*

Phone (Employer)

Your Job Title*

Supervisor/Manager*

Dates Employed*

Starting Hourly Rate/Salary*

Ending Hourly Rate/Salary*

Work Performed*

Write Here

Reason For Leaving*

Write Here

Employer Name

Address

Street

City

State

ZIP

Phone Number

Phone (Employer)

Your Job Title

Supervisor/Manager

Dates Employed

Starting Hourly Rate/Salary

Ending Hourly Rate/Salary

Work Performed

Write Here

Reason For Leaving

Write Here

References

Name*

Phone Number*

Phone

Address*

Street

City

State

ZIP

Name*

Phone Number*

Phone

Address*

Street

City

State

ZIP

Name*

Phone Number*

Phone

Address*

Street

City

State

ZIP

Submit Application

Veteran Eligibility

You must be a North Dakota resident and have served in the active military forces during a period of war or received the armed forces expeditionary or other campaign service medal during an emergency condition and must have been released under other than dishonorable conditions. See NDCC 39-19.1 et Seq.

Do you claim Veteran's Preference?*

If 'Yes', you must attach a DD-214, Report of Separation, in the 'File Upload' box below.

Do you claim Disabled Veteran's Preference?*

If 'Yes', you must attach a DD-214, Report of Separation and a letter less than one year old from the US Department of Veterans Affairs indicating disability. Use the 'File Upload' box below.

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.

I certify that the information in this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Stutsman County to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of Stutsman County serve at-will, and the employment relationship may be terminated at any time by either party, for any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, to file a State security questionnaire and State loyalty oath, and to comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for only hours worked, and would be ineligible for benefits including paid time off. If employed on a regular, benefits-eligible basis, I understand that I would be required to make mandatory contributions to the Stutsman County Retirement System or to an optional retirement program, if applicable. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first SIX MONTHS of regular employment represent a probational period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal.

By digitally signing or typing your name into the Applicant Signature box below, you are confirming that the above statements are true. You agree that you are electronically signing this document.

Applicant Signature

Full Name

If you are unable to use the signature pad above, type your full name below

Name

Date*

Select Date ×

Upload cover letter, resumes, and additional documentation below

File Upload

Drag 'n Drop files here

Max file size: 25.00 MB. | Allowed file types: gif,jpeg,png,jpg,bmp,tiff,doc,docx,xls,xlsx,pdf | Max number of files: 5

Select File(s)

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PLEASE ANSWER THE FOLLOWING TWO SECURITY QUESTIONS:

5 plus 8 equals?*

Prove you are a human

Write here

9 plus 1 equals?*

Prove you are a human

Write here

Education

Skills, Credentials & Licenses

Work Experience

References

Submit Application

Veteran Eligibility

Applicant Signature

Upload cover letter, resumes, and additional documentation below

File Upload

Your application has been successfully submitted.