Employment

APPLICATION FOR EMPLOYMENT

Today's Date(Required)

Name(Required)

First Middle Last

Other last names which you have used and/or under which you have been employed:

Primary Phone(Required)

Secondary Phone

Email(Required)

Social Security Number(Required)

Under 18 years old?(Required)

Yes

Address(Required)

Street Address Address Line 2 City State ZIP Code

How many years have you lived at this address?(Required)

Previous Address

Street Address Address Line 2 City State ZIP Code

How long did you live at your previous address?

Do you have access to daily transportation?(Required)

Yes

Are you legally eligible to work in the United States?(Required)

Yes

Which job(s)s did you apply for?(Required)

Use + to add more than one job.

Employment Type Preference(Required)

Would you be available to work all shifts?(Required)

Yes

Comments

If hired, on what date will you be available to start work?(Required)

Are there any other experiences, skills or qualifications which you feel would be relevant for work at SRCCC?(Required)

Do you have any family member who is an employee at SRCCC?(Required)

Yes

List first/last name of family member(Required)

Do you have any family member who serves on the Facility Governing Board?(Required)

Yes

List first/last name of family member(Required)

Education History

Name of High School(Required)

Location of High School(Required)

City State

Did you graduate?(Required)

Yes

Did you attend college/university?(Required)

Yes

Name of college/university(Required)

Location of college/university(Required)

City State

Major(Required)

Did you graduate?(Required)

Yes

Do you have other educational experiences to add?(Required)

Yes

Name of school or program(Required)

Location of school or program(Required)

City State

Major(Required)

Did you graduate?(Required)

Yes

Employment History

Including Military History – Start with Present or Most Recent Job

Employment Start Date(Required)

Employment End Date(Required)

Employer(Required)

Job Title(Required)

Duties(Required)

Supervisor's Name(Required)

First Last

Supervisor's Business Phone(Required)

Starting Salary(Required)

Ending Salary(Required)

Reason for leaving(Required)

May we contact this employer?(Required)

Yes

Do you have another employment to add? (2)(Required)

Yes

Employment Start Date(Required)

Employment End Date(Required)

Employer(Required)

Job Title(Required)

Duties(Required)

Supervisor's Name(Required)

First Last

Supervisor's Business Phone(Required)

Starting Salary(Required)

Ending Salary(Required)

Reason for leaving(Required)

May we contact this employer?(Required)

Yes

Do you have another employment to add? (3)(Required)

Yes

Employment Start Date(Required)

Employment End Date(Required)

Employer(Required)

Job Title(Required)

Duties(Required)

Supervisor's Name(Required)

First Last

Supervisor's Business Phone(Required)

Starting Salary(Required)

Ending Salary(Required)

Reason for leaving(Required)

May we contact this employer?(Required)

Yes

What computer software/systems are you proficient in?(Required)

Professional References

Other than relatives.

Reference #1 Name(Required)

First Last

Reference #1 Address(Required)

Street Address Address Line 2 City State ZIP Code

Reference #1 Occupation(Required)

Reference #1 Phone(Required)

Reference #2 Name(Required)

First Last

Reference #2 Address(Required)

Street Address Address Line 2 City State ZIP Code

Reference #2 Occupation(Required)

Reference #2 Phone(Required)

Reference #3 Name(Required)

First Last

Reference #3 Address(Required)

Street Address Address Line 2 City State ZIP Code

Reference #3 Occupation(Required)

Reference #3 Phone(Required)

Additional Questions

Occasionally the form of application makes it difficult for an individual to adequately summarize their complete background. To assist us in finding the proper position for you at SRCCC, use the space below to summarize any additional information necessary to describe your full qualifications.

Why do you want to work in community corrections?(Required)

Application Signature

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize prior employers, schools, or institutions to disclose any and all information concerning my employment or attendance and any pertinent information they may have, personal or otherwise to the Stark Regional Community Correction Center, and relieve all parities from liability from providing same. A copy of this authorization shall be considered as valid as the original. In the event of my employment, I understand that false or misleading information given in my application, any documents submitted to be considered for my qualification for this job, or interview(s) shall result in discharge. I also understand that I am required to abide by all policies, procedures, rules and regulations of the employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either myself or the Stark Regional Community Correction Center. I understand that no Stark Regional Community Correction Center representative, other than the Director, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. Nothing stated herein, or elsewhere, invalidates the employment-at-will relationship nor creates a contract of employment with Stark Regional Community Correction Center or the Governing Board.

I understand that any offer of employment is contingent upon my ability to comply with regulations required by form I-9 establishing my identity and right to work in the United States.

Satisfactory results from a criminal history background check, Bureau of Motor Vehicle check, a drug screen, official school transcripts and a medical examination will be required if an offer of employment is made but prior to the commencement of employment.

I hereby certify that the facts in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application, any documents submitted to be considered for any qualification for the job, or made during interviews(s) shall be considered sufficient cause for dismissal.

Electronic Signature and Date(Required)

Please include FIRST and LAST NAME with DATE to indicate you consent to the above. This electronic signature constitutes your agreement.