APPLICATION FOR EMPLOYMENT
DOUGLAS COUNTY, NEVADA

HUMAN RESOURCES
(775) 782-9860
Fax (775) 782-9083
www.douglascountyhr.com

Dear Applicant,

Thank you for your interest in employment with Douglas County. We would like to take this opportunity to explain our recruitment process and answer some frequently asked questions.

♦  Applications are accepted for open positions only. Please indicate the title of the position for which you are applying on EACH application.

♦  You may access our application and open positions at our WEBSITE www.douglascountyhr.com or our JOBLINE at (775) 782-9824.

♦  A MASTER application may be completed. A clear photocopy of the application is acceptable for each position for which you are applying. Please provide a specific job title, original signature and current date on EACH photocopy. Please be advised that Human Resources is not able to make photocopies for applicants.

♦  Faxed applications are acceptable. Our fax number is (775) 782-9083.

♦  Resumes are not accepted in lieu of applications. However, applicants may attach a resume to their completed application.

♦  Applications and ALL REQUIRED DOCUMENTATION must be received by our office, on or before the closing date. Please be advised that no exceptions will be made.

♦  Please allow at least two weeks after the closing date for processing, before contacting our office regarding the status of the position. You will receive a written response from us within 30 days unless the recruitment is delayed.

If you have any further questions, please do not hesitate to contact our office. Once again, thank you for your interest in employment with Douglas County. Douglas County Human Resources Staff

 

Douglas County HR

DOUGLAS COUNTY
EMPLOYMENT APPLICATION
 Received

Human Resources
1616 8th Street, P. O. Box 218
Minden, NV 89423
(775) 782-9860 – (775) 782-9912 TDD – (775) 782-9083 Fax

If you have a disability and believe you require special accommodations during the selection process, please contact Human
Resources to make the appropriate arrangements.

Position Applied For:

 Full-Time Part-Time Temporary/Seasonal
  

Please answer each question completely. Please type or print clearly and legibly. Applications not filled out completely will not be considered. Return completed application to Douglas County Human Resources. Separate applications must be filed for each position. Photocopies of this application will be accepted with an original signature. Faxed copies are accepted by the deadline date at (775) 782-9083, with the original application due within one week. Resumes accepted when attached to a completed application.

Name    Date
Address  Email Address  
City  State  Zip Code  Telephone ()
                                                                                                                                     Cell Phone ()

On what date would you be available for work?
Have you received a job announcement for this position? Yes No
Do you understand the job requirements for this position? Yes No
Can you perform the requirements of this job with or without reasonable accommodations? Yes No
Are you at least 18 years of age?
If No, please state your age:
 		 Yes No
Have you ever been employed by Douglas County?
If Yes, state the year employed and department:
 		 Yes No
Do you have relatives employed by Douglas County? Yes No
If Yes, please list name(s), and departments where employed:
Name  Department  Relationship
Name  Department  Relationship
 
Are you legally eligible to work in the United States? Yes No
Following an offer of employment, you will be required to submit verification of your legal right to work in the United States.
 
Have you ever been convicted of a crime (other than a minor traffic violation)? Yes No
If yes, state the date, location and nature of the offense:
 

Have you ever been discharged or terminated from any place of employment? Yes No
If so, please explain:
 NOTE: A termination or a conviction will not necessarily disqualify you from employment. It will be considered in terms of work to be performed.

Page 2
 Douglas County Employment Application

List job-related Certificates/Licenses, Registrations or Training related to the position for which you are applying:

  Date Completed

SPECIAL SKILLS:
List any special skills you possess and/or equipment/tools or office machines you can operate related to this position:

Type: WPM  Computer/Software Skills

EDUCATION RECORD

Are you currently a student? Yes No
Did you graduate from high school? Yes No
If No, did you receive a GED certificate? Yes No

School Name And Location Units Major Study H.S. Diploma/Degree Earned
High School    
College
Trade/Business
Graduate School

MILITARY SERVICE

Have you ever been a member of the Armed Forces? Yes  No
Branch  Rank  Discharge Type

Duties:
 

Page 3
Douglas County Employment Application


EMPLOYMENT HISTORY
 Provide information regarding all paid, military, and volunteer work within the past ten years. Describe your current or most recent position first;
then list other relevant positions in order, working down from the most recent. Use a separate block for each position – even if employment was
with the same organization. Use additional sheets if necessary. Do NOT use references such as “See Resume” in place of completing this section.
Insufficiently completed applications will not be considered.

Employer:  Position:
Address:  From: (Mo/Yr)  To: (Mo/Yr)
Starting Salary: Ending Salary:  Number of Employees Supervised:
Supervisor’s Name/Title: Telephone:
Related Duties:

Reason for Leaving:

Employer:  Position:
Address:  From: (Mo/Yr)  To: (Mo/Yr)
Starting Salary: Ending Salary:  Number of Employees Supervised:
Supervisor’s Name/Title: Telephone:
Related Duties:

Reason for Leaving:

Employer:  Position:
Address:  From: (Mo/Yr)  To: (Mo/Yr)
Starting Salary: Ending Salary:  Number of Employees Supervised:
Supervisor’s Name/Title: Telephone:
Related Duties:

Reason for Leaving:

Page 4
Douglas County Employment Application
 

Employer:  Position:
Address:  From: (Mo/Yr)  To: (Mo/Yr)
Starting Salary: Ending Salary:  Number of Employees Supervised:
Supervisor’s Name/Title: Telephone:
Related Duties:

Reason for Leaving:

May we contact all employers listed? Yes  No (Attach a list of any exceptions with an explanation).
Please state below any other information that would be helpful in determining your qualifications for this position. You may include
significant accomplishments, previous career highlights, or any other information that is not included in this employment application.

PERSONAL REFERENCES
Give the name, address (home or business) and telephone number of three persons NOT RELATED to you and NOT former
employers who have knowledge of your character, work experience, ability and accomplishments.

Name Address Occupation Telephone

ACKNOWLEDGMENTS
Please READ ALL of the following statements and INITIAL EACH to indicate you have read and understand each of the
statements. If you have questions, contact Human Resources at (775) 782-9860.
  All offers of employment and all information regarding compensation and other terms and conditions of employment will
be made in writing. Verbal statements may not be relied upon.

 Employment will be at will unless specifically stated to be otherwise. “At will” means Douglas County may terminate my
employment at any time with no advance notice and for any reason or no reason.

  This application is the property of Douglas County and will become part of my personnel file if I am hired.

I certify that all statements contained on this application are true and correct. I authorize Douglas County to investigate my references and to make an
independent investigation of any character, conduct and employment records; including, but not limited to, criminal and traffic records. I hereby
release all employers, schools, or persons from all liability in responding to inquiries in connection with my application. I understand that any
misrepresentation, falsification or material omission of information may result in my failure to receive an offer, or if I have been hired, in my dismissal
from employment, regardless of length of employment. In the event I am employed by Douglas County, I agree to comply with all rules and policies.

APPLICANT DATA RECORD
(NOT FOR PERSONNEL FILE)

Date
Position Applied For

The information requested on this form will be used by Douglas County Human Resources for research and statistical purposes only. Federal and State laws make it unlawful to discriminate in employment on the basis of race, color, religion, national origin, disability or age. Your participation is voluntary and would be greatly appreciated. This information will be kept separate and confidential and will not be used to make any employment decision.

Date of Birth  Male  Female
Are you a disabled veteran?  Yes  No
Are you a veteran of the Vietnam era?  Yes  No

Choose one ethnic group with which you most closely identify:
  White
  Black
  Hispanic or Latino
 Native Hawaiian /Pacific Islander
  American Indian/Alaskan Native

 Asian

 Two/More Races (Not Hispanic/Latino)

How were you referred?
  Walk-In
  Newspaper (please specify)
 Job Flyer
  State Employment Office
  Professional Journal or Trade Publication (please specify)
  College Placement Service
  Friend or Relative
  County Employee
  Other (please specify)

 

Important Notice - Once you submit the document, your information will immediately be sent to the Human Resources Department and a copy will be displayed on your desktop in an Adobe PDF document. No further confirmations, or notifications will be sent.