University of Nevada, Reno
P.O. Box 8970 • Reno, NV 89507
EMPLOYMENT APPLICATION
The National Council of Juvenile and Family Court Judges (NCJFCJ) is an equal opportunity employer. No question on this application is asked for the purpose of excluding any applicant’s consideration for employment because of race, sex, age, color, religion, marital status, sexual orientation, veteran status, status with regard to public assistance (e.g. welfare payments), source of income, national origin, citizen status, or physical or mental disability. Employment with NCJFCJ shall be based solely on the Company’s requirements and the individual’s qualifications.
LAST NAME, FIRST NAME, MIDDLE INITIAL / E-MAIL ADDRESS / OTHER NAMES KNOWN BY OR WORKED UNDER (FOR REFERENCE CHECKING PURPOSES)PRESENT ADDRESS: STREET/CITY/STATE/ZIP / TELEPHONE NUMBER
POSITION APPLIED FOR / AVAILABLE START DATE / WAGE REQUIRED / AT LEAST 18 YEARS OF AGE?
YES NO / PREFERENCE:
FULL TIME
PART TIME
CAN YOU PROVIDE PROOF OF ELIGIBILITY TO WORK IN THE UNITED STATES
YES NO / ARE YOU WILLING TO RELOCATE
YES NO
EMPLOYMENT HISTORY
(Please provide employment history for the last seven years. Use an additional sheet if necessary.)
FROM TO / NAME OF CURRENT EMPLOYER
POSITION TITLE / ADDRESS: STREET/CITY/STATE/ZIP
MAY WE CONTACT THIS EMPLOYER?
YES NO / WAGE / SUPERVISOR’S NAME, TITLE, AND TELEPHONE NUMBER
REASON FOR LEAVING / JOB DUTIES
EMPLOYMENT DATES
FROM TO / NAME OF PREVIOUS EMPLOYER
POSITION TITLE / ADDRESS: STREET/CITY/STATE/ZIP
MAY WE CONTACT THIS EMPLOYER?
YES NO / WAGE / SUPERVISOR’S NAME, TITLE, AND TELEPHONE NUMBER
REASON FOR LEAVING / JOB DUTIES
EMPLOYMENT DATES
FROM TO / NAME OF PREVIOUS EMPLOYER
POSITION TITLE / ADDRESS: STREET/CITY/STATE/ZIP
MAY WE CONTACT THIS EMPLOYER?
YES NO / WAGE / SUPERVISOR’S NAME, TITLE, AND TELEPHONE NUMBER
REASON FOR LEAVING / JOB DUTIES
Applicant Name:
EMPLOYMENT HISTORY (continued)
EMPLOYMENT DATESFROM TO / NAME OF PREVIOUS EMPLOYER
POSITION TITLE / ADDRESS: STREET/CITY/STATE/ZIP
MAY WE CONTACT THIS EMPLOYER?
YES NO / WAGE / SUPERVISOR’S NAME, TITLE, AND TELEPHONE NUMBER
REASON FOR LEAVING / JOB DUTIES
EMPLOYMENT DATES
FROM TO / NAME OF PREVIOUS EMPLOYER
POSITION TITLE / ADDRESS: STREET/CITY/STATE/ZIP
MAY WE CONTACT THIS EMPLOYER?
YES NO / WAGE / SUPERVISOR’S NAME, TITLE, AND TELEPHONE NUMBER
REASON FOR LEAVING / JOB DUTIES
EMPLOYMENT DATES
FROM TO / NAME OF PREVIOUS EMPLOYER
POSITION TITLE / ADDRESS: STREET/CITY/STATE/ZIP
MAY WE CONTACT THIS EMPLOYER?
YES NO / WAGE / SUPERVISOR’S NAME, TITLE, AND TELEPHONE NUMBER
REASON FOR LEAVING / JOB DUTIES
EMPLOYMENT DATES
FROM TO / NAME OF PREVIOUS EMPLOYER
POSITION TITLE / ADDRESS: STREET/CITY/STATE/ZIP
MAY WE CONTACT THIS EMPLOYER?
YES NO / WAGE / SUPERVISOR’S NAME, TITLE, AND TELEPHONE NUMBER
REASON FOR LEAVING / JOB DUTIES
EMPLOYMENT DATES
FROM TO / NAME OF PREVIOUS EMPLOYER
POSITION TITLE / ADDRESS: STREET/CITY/STATE/ZIP
MAY WE CONTACT THIS EMPLOYER?
YES NO / WAGE / SUPERVISOR’S NAME, TITLE, AND TELEPHONE NUMBER
REASON FOR LEAVING / JOB DUTIES
EDUCATION
NAME, CITY, AND STATE OF SCHOOL / NO. OF YEARS COMPLETED / MAJOR/MINOR ORGENRE OF COURSES / TYPE OF DEGREE / ADD’L COMMENTS
SECONDARY EDUCATION:
HIGHER EDUCATION:
HIGHER EDUCATION:
MASTERS/JD/PhD:
MASTERS/JD/PhD:
TRADE OR BUSINESS:
OTHER (CORRESPONDENCE COURSES, SEMINARS, WORKSHOPS):
JOB-RELATED SKILLS
1. LIST ANY JOB-RELATED EXPERIENCES OR SKILLS, INCLUDING RELEVANT COMPUTER PROGRAMS, DATABASE SYSTEMS, ETC.:(COMPLETE THIS SECTION IF YOU ARE APPLYING FOR A POSITION WHERE DRIVING A VEHICLE IS NECESSARY FOR JOB PERFORMANCE)
2. DO YOU HAVE A VALID DRIVERS LICENSE? YES* NO
A. *LICENSE NUMBER: *ISSUING STATE:
3. INDICATE NUMBER OF TRAFFIC VIOLATIONS RECEIVED WITHIN THE PAST THREE YEARS(PROVIDE EXPLANATION IF NECESSARY):
GENERAL
1. ARE YOU WILLING TO TRAVEL AS REQUIRED?YES* NO
A. *INDICATE PERCENTAGE OF TIME: UP TO% / 2. ARE YOU NOW WORKING MORE THAN ONE JOB AT A TIME? YES* NO
A. *PLEASE EXPLAIN: / 3. HAVE YOU PREVIOUSLY WORKED FOR NCJFCJ?
YES* NO
A. *INDICATE WHEN AND UNDER WHAT NAME:
4. HAVE YOU BEEN CONVICTED OF A FELONY, OR WITHIN THE LAST 5 YEARS A MISDEMEANOR WHICH RESULTED IN IMPRISONMENT?* YES** NO
*A prior conviction will not necessarily bar you from employment. / A. **CHARGE: / C. **LOCATION:
B. **DATE: / D. **COURT:
5. HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN? YES* NO
A. *PLEASE EXPLAIN:
6. IF AN OFFER OF EMPLOYMENT IS MADE, YOU MAY BE REQUIRED TO UNDERGO BACKGROUND CHECKS AND/OR A DRUG TEST, THE RESULTS OF WHICH MAY AFFECT THE OFFER OF EMPLOYMENT. ARE YOU WILLING TO UNDERGO SUCH AN EXAMINATION?
YES NO
7. WHAT PROMPTED YOUR APPLICATION FOR THIS POSITION:
A. HOW DID YOU LEARN ABOUT THIS POSITION – SPECIFY SOURCE OF ADVERTISEMENT: PLEASE SELECT FROM THIS LISTNCJFCJ Web siteNCJJ Web siteLinkedInNCJFCJ Diversity listservNevada JobCentralItsAboutJobsNV Nonprofit NewsUNR Career NavigatorPhilanthropy News DigestProNetAmerica's Job ExchangeRenoHelpWanted.comIndeed.comOther Job Board
IF “OTHER” PLEASE INDICATE:
B. IF EMPLOYEE REFERRAL, PLEASE SPECIFY NCJFCJ EMPLOYEE’S NAME:
AFFIDAVIT – PLEASE READ CAREFULLY
To the best of my knowledge, I have truthfully disclosed all information asked for in this application. Any applicant will be immediately rejected for employment or, if hired, terminated without notice for giving false information in this application or failing to accurately provide information requested. If hired, employment is for no fixed term and the company or employee can terminate employment at any time.
I authorize contact with any person or entity named in this application and any other person or entity who may have knowledge concerning my past for the purpose of obtaining information material to my qualifications and suitability for employment.
I authorize all of those with whom I am acquainted – previous employers, professionals, institutions, neighbors, friends, agencies asked to provide criminal conviction history and others – to furnish any and all information they may have concerning me which may be material to my qualifications and suitability for the job for which I have applied.
Since all employees are hired for an indefinite and unspecified duration, employment is not guaranteed for any specific length of time. Employment is at the mutual consent of the employee and the company. Accordingly, either the employee or the company can terminate the employment relationship at will, at any time, with or without cause or advance notice. Furthermore, no employee or representative of the company, other than the Chief Executive Officer, has any power or legal authority to alter the at-will nature of the employment relationship. Only the Chief Executive Officercan alter the nature of the relationship via a written agreement that is signed both by the Chief Executive Officerand the employee involved.
APPLICANT’S SIGNATURE: DATE:
(Typing in your full name will act as your legal signature)
______
PROFESSIONAL REFERENCES (THREE REQUIRED)
1.Name:
Title:
Business:
Address:
City/State/Zip:
Phone:
E-mail:
2.Name:
Title:
Business:
Address:
City/State/Zip:
Phone:
E-mail:
3.Name:
Title:
Business:
Address:
City/State/Zip:
Phone:
E-mail:
Applicant Name: Date:
EEOC/AFFIRMATIVE ACTION – INVITATION TO SELF IDENTIFY
The National Council of Juvenile and Family Court Judges (NCJFCJ) is an Equal Opportunity Employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program. This data is for equal employment opportunity and affirmative action only. NCJFCJ invites employees and applicants to voluntarily self-identify their gender, race, and ethnicity. The information will be kept confidential and will be used only in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.[1]
COMPLETION OF THIS FORM IS VOLUNTARY AND IN NO WAY AFFECTS THE DECISION REGARDING YOUR APPLICATION FOR EMPLOYMENT OR EXISTING EMPLOYMENT RELATIONSHIP. THIS FORM IS CONFIDENTIAL AND WILL BE MAINTAINED SEPARATELY FROM YOUR APPLICATION FORM.
Gender
Female Male
Ethnicity
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
Yes No
Race
White (Not Hispanic or Latino):A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American (Not Hispanic or Latino):A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian (Not Hispanic or Latino):A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino)*:All persons who identify with more than one of the above five races. *Please specify with which races you identify by marking above next to the appropriate racial categories.
I do not wish to self-identify.
Name:
(Typing in your full name will act as your legal signature)
Position Applied For/Held: Date:
[1] Equal Employment Opportunity Commission, November 7, 2006, “Final Revisions of the Employer Information Report (EEO-1),” < accessed March 12, 2007.