Employment Application

It is the policy of Muscatine County not to discriminate against any employee or applicant for employment because of race, creed, color, sex, national origin, ancestry, religion, age, political affiliation, or disability. Muscatine County is an EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER, and recognizes the requirements of THE AMERICANS WITH DISABILITIES ACT

Muscatine County requires a separate application for each available position.

All questions must be answered in full. Resumes will not be accepted in place of completing this form but may be attached, if desired. False statements or misrepresentation on this application shall be considered grounds for disqualification, discipline, or termination.

1. Date
2. Position you are applying for Choose an open position. Correctional Officer - Muscatine County Jail Deputy Sheriff Summer Conservation Aide Transport Officer II
3. Last Name
4. First Name
5. Middle Name
6. Number and Street, R.F.D., or P.O. Box Number
7. City
8. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
9. Zip
10. Email
11. Primary Phone
12. Driver's License #
13. Driver's License State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

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14. Date Available for Employment
15. Are you 18 years or older? Please Select Yes No
16. Type of work you would be seeking
17. If you have relatives presently employed by Muscatine County...List name
18. Department
19. Relationship to you
20. Are you a veteran of the United States Military Service? Please Select Yes No
21. Are you claiming Veteran's Preference in employment? Please Select Yes No
If yes, copy of military form DD214 must be included with application
Date of Duty (From)
Date of Duty (To)
Type of Discharge
22. Have you been convicted of a violation of the law other than minor traffic offenses? If you have a fugitive record, or record of a felony, aggravated misdemeanor, or serious misdemeanor you cannot be hired as a 911 Communications Specialist and should not apply. Please Select Yes No
If Yes, please explain.
23. Are you fluent in any language other than English? Please Select Yes No
If yes, which language(s)

To properly evaluate your application, we need information concerning your education skills and trades you have acquired in addition to your work record. Please answer all questions as completely as possible.

Education

24. Are you a high school graduate or equivalent? Please Select Yes No
If no, last grade completed

Educational Institution 1

1. Name of educational institution attended
2. Location
3. Zip
4. Year Graduated

Educational Institution 2

1. Name of educational institution attended
2. Location
3. Zip
4. Year Graduated

Educational Institution 3

1. Name of educational institution attended
2. Location
3. Zip
4. Year Graduated

Educational Institution 4

1. Name of educational institution attended
2. Location
3. Zip
4. Year Graduated

Training and Special Skills

1. List any special training (vocational school, short courses special seminars, business schools, workshops, etc.), that you have completed and show dates of each.
2. List any special skills you may have in the operation of machinery, equipment, office machines, etc., which you are able to operate in a competent manner.
3. If job description requires a Chauffeur’s Permit or Commercial Driver’s License, do you have or would you be able to obtain such a permit Please Select Yes No

References

List three (3) individuals who know you well enough to give information about your work experience, training, or special skills/abilities for the job you are applying for. Do not include relatives or former supervisors.

Reference 1

1. Name
2. Address
3. City
4. State
5. Zip
6. How Acquainted
7. Length of Acquaintance
8. Tel. Contact No

Reference 2

1. Name
2. Address
3. City
4. State
5. Zip
6. How Acquainted
7. Length of Acquaintance
8. Tel. Contact No

Reference 3

1. Name
2. Address
3. City
4. State
5. Zip
6. How Acquainted
7. Length of Acquaintance
8. Tel. Contact No

Employment History

Start with your present or last position and list all previous employment. Include paid and unpaid, full or part-time, military, summer jobs, periods of unemployment, etc. All information must be included in order for your application to be given full consideration Resumes may substitute for the description of duties and responsibilities.
25. If you are currently employed, may we check with your present supervisor? Please Select Yes No

Employer 1

1. Name of last employer
2. Supervisor's name, title, phone number
3. Address of last employer
4. City
5. State
6. Zip
7. Type of Business
8. Starting Date
9. Ending Date
10. Your Job Title
11. Reason For Leaving
12. Starting Salary
13. Ending Salary
14. Full-time or Part-time Please Select Full-time Part-time
15. Hours per week
16. Description of duties and responsibilities
Add Employer

Employer 2

1. Name of last employer
2. Supervisor's name, title, phone number
3. Address of last employer
4. City
5. State
6. Zip
7. Type of Business
8. Starting Date
9. Ending Date
10. Your Job Title
11. Reason For Leaving
12. Starting Salary
13. Ending Salary
14. Full-time or Part-time Please Select Full-time Part-time
15. Hours per week
16. Description of duties and responsibilities
Add Employer

PLEASE READ BEFORE SIGNING

Your Signature

1. Signature of Applicant Please type your full name to serve as an electronic signature.
2. Date

TO ALL APPLICANTS

PLEASE ANSWER THE FOLLOWING QUESTIONS

1. Sex Please Select Male Female
2. What is your age?
3. Of which ethnic/racial group do you consider yourself a member? Please Select White African-American Asian/Pacific Islander Hispanic Native American Other
4. Are you a disabled applicant? Please Select Yes No
5. If you require accommodation for testing, interview, or employment procedures, please describe:
6. How did you learn about the job for which you are applying? Please Select Muscatine County Job Posting Board Job Service of Iowa County Employee Newspaper Other Source
Newspaper Name
Other Source Name
7. Applicant Name
8. reCAPTCHA