IMPORTANT INSTRUCTIONS FOR COMPLETING THE WASHOE COUNTY APPLICATION FORM

LIST ALL JOBS IN REVERSE ORDER, STARTING WITH YOUR PRESENT OR LAST JOB.

LIST YOUR ENTIRE WORK HISTORY INCLUDING PART-TIME, TEMPORARY, SELF-EMPLOYMENT, VOLUNTEER AND MILITARY JOBS.

LIST EACH PROMOTION AS A SEPARATE JOB, EVEN IF IT WAS WITHIN THE SAME ORGANIZATION.

LIST ALL IMPORTANT AND/OR TIME-CONSUMING DUTIES.

RESUMES MAY NOT BE SUBSTITUTED FOR THIS APPLICATION OR ANY OF ITS PARTS. INCOMPLETE APPLICATIONS MAY BE REJECTED.

EXAMPLES OF WORK, AWARDS, LETTERS, ETC., MAY BE TAKEN TO THE EMPLOYMENT INTERVIEW NOT ATTACHED (UNLESS NOTED) TO THE APPLICATION.

THIS APPLICATION FORM AND ITS ATTACHMENTS ARE OFFICIAL PROPERTY OF THE COUNTY AND CANNOT BE RETURNED, REUSED OR COPIED AFTER BEING SUBMITTED.

YOU SHOULD RETAIN A COPY OF THIS APPLICATION FOR FUTURE USE OR REFERENCE.

PLEASE FILL OUT FORM IN INK, PRINT OR TYPE.	ATTACH CERTIFICATES, TRANSCRIPTS, LICENSE COPIES, ETC., ONLY IF REQUIRED BY JOB ANNOUNCEMENT.	RETAIN A COPY OF YOUR COMPLETED APPLICATION FOR YOUR RECORDS.

EMPLOYMENT QUESTIONNAIRE
The following information will be used in the Washoe County Department of 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, sex, sexual orientation, gender identify and expression, age, disability or national origin in the activities and/or services which it provides. 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.
I first learned of this recruitment through (check one):	Choose one ethnic group with which you most closely identify:
Job Announcement I Walk-in County Department of Human Resources Washoe County Website Social Media Washoe County Employee / Department (other than HR) Job Connect Ad in Newspaper / Publication Professional Trade Journal / Organization / Conference Letter / Email / cMail from Human Resources College/ Technical School Job Fair Parent / Guardian Returning Seasonal Work Reno America’s Job Bank / CareerBuilder Other Internet Site Not listed above Prefer not to disclose	White Black or African American Hispanic or Latino Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Prefer not to disclose Choose one ethnic group with which you most closely identify:
Date of Birth (mm/dd/yyyy): Gender: Male Female	Hispanic or Latino Asian

1001 E. NINTH ST. RENO NV 89512 775-328-2081 PHONE 775-328-6119 FAX www.washoecounty.us WASHOE COUNTY

APPLICATION FOR EMPLOYMENT

(TEMPORARY & INTERMITTENT HOURLY POSITIONS ONLY)

JOB ANNOUNCEMENT NUMBER:	TITLE OF JOB FOR WHICH YOU ARE APPLYING:	SOCIAL SECURITY NUMBER: (Optional)
LAST NAME, FIRST NAME, MIDDLE INITIAL (Please Print Clearly):
CURRENT MAILING ADDRESS (HOUSE OR APT.#, STREET, PO BOX, etc.) (ADDRESS, CITY, STATE, ZIP)	ADDRESS CITY, STATE, ZIP
HOME PHONE: (xxx)xxx-xxxx	BUSINESS/MSG PHONE:	VALID DRIVERS LICENSE NUMBER / STATE / EXPIRE DATE	/ /
E-MAIL ADDRESS: xxx@xxmail.com	HAVE YOU EVER BEEN EMPLOYED BY WASHOE COUNTY: (If your answer is yes, please use either the back of this form, or an additional sheet to list the specific dates, job title, department, and name of your supervisor. Omission of this information may lead to disqualification or dismissal.)	YES NO
IMPORTANT: ARE YOU A VETERAN? Eligible veterans who were honorably discharged from the U.S. Armed Forces shall receive one (1) bonus point upon passing open competitive examinations. In order to be given a bonus point, applicants much show proof of HONORABLE DISCHARGE (DD 214 with Classification of Discharge) prior to establishment of the eligible list. Six month reservists are not eligible.	YES NO
IMPORTANT: PLEASE LIST DEPARTMENT(S) OF INTEREST:
IF APPLICABLE, PLEASE LIST DEPARTMENT(S) DO NOT WISH TO INTERVIEW WITH:
JOB AVAILABILITY:	SHIFT AVAILABILITY:	AREA AVAILABILITY:	AVAILABLE DATE:
FULL-TIME PART-TIME (20+ HRS PER WK) TEMPORARY (6 MOS OR LESS) INTERMITTENT HOURLY (ON-CALL)	DAY SWING SHIFT SWING SHIFT WEEKEND ROTATING	RENO / SPARKS INCLINE VILLAGE GERLACH VYA	AVAILABLE IMMEDIATELY 2 OR MORE WEEKS NOTICE NOT AVAILABLE NOW, BUT WILL BE
LIST JOB-RELATED CERTIFICATES / LICENSES, REGISTRATIONS, TYPING/DATA ENTRY, SHORTHAND SPEED, BILINGUAL, AND OTHER SPECIAL ABILITIES, ETC.:
Title	State	Title	State	Bilingual:	Yes No
Number	Expiration Date	Number	Expiration Date	Languages:
DID YOU GRADUATE FROM HIGH SCHOOL:	YES	NO	IF NOT, HAVE YOU PASSED A G.E.D. TEST:	YES	NO
NAME AND LOCATION OF COLLEGES OR TRADE SCHOOLS ATTENDED.	DATES ATTENDED	CREDITS COMPLETED	MAJOR	UNITS IN MAJOR	DEGREES OR CERTIFICATES RECEIVED
** THIS AREA FOR OFFICE USE ONLY **
EVALUATED BY:	DATE:
ACCEPT	REJECT-EXPERIENCE	REJECT-EDUCATION	REJECT – NO REQUIRED LICENSE/CERTIFICATION	REJECT-TYPING	REJECT-OTHER:
REEVALUATED BY:	DATE:
ACCEPT	REJECT	COMMENTS:
APPLICATION ENCODED BY:	DATE:	PROOFED:
WASHOE COUNTY IS AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER HIRING EMPLOYMENT ELIGIBLE APPLICANTS.
PLEASE LIST JOBS BEGINNING WITH THE MOST RECENT
1. EMPLOYER NAME:	EMPLOYER LOCATION:
From Date (mm/dd/yr):	To Date (mm/dd/yr):	Hrs./Wk. (40hrs/wk)	/Wk
Full- Time:	(check only one)	Part-Time:	(check only one)	Monthly Salary:
Your Title:	Immediate Supervisor:	Employer/Supervisor Phone Number:
Duties:
Machines / Equipment used:	Number and Title of people supervised:	Reason for leaving:
2. EMPLOYER NAME:	EMPLOYER LOCATION:
From Date (mm/dd/yr):	To Date (mm/dd/yr):	Hrs./Wk. (40hrs/wk)	/Wk
Full- Time:	(check only one)	Part-Time:	(check only one)	Monthly Salary:
Your Title:	Immediate Supervisor:	Employer/Supervisor Phone Number:
Duties:
Machines / Equipment used:	Number and Title of people supervised:	Reason for leaving:
3. EMPLOYER NAME:	EMPLOYER LOCATION:
From Date (mm/dd/yr):	To Date (mm/dd/yr):	Hrs./Wk. (40hrs/wk)	/Wk
Full- Time:	(check only one)	Part-Time:	(check only one)	Monthly Salary:
Your Title:	Immediate Supervisor:	Employer/Supervisor Phone Number:
Duties:
Machines / Equipment used:	Number and Title of people supervised:	Reason for leaving:
4. EMPLOYER NAME:	EMPLOYER LOCATION:
From Date (mm/dd/yr):	To Date (mm/dd/yr):	Hrs./Wk. (40hrs/wk)	/Wk
Full- Time:	(check only one)	Part-Time:	(check only one)	Monthly Salary:
Your Title:	Immediate Supervisor:	Employer/Supervisor Phone Number:
Duties:
Machines / Equipment used:	Number and Title of people supervised:	Reason for leaving:
PLEASE LIST JOBS (CONTINUED) WITH SIGNATURE / ACKNOWLEDGEMENT
5. EMPLOYER NAME:	EMPLOYER LOCATION:
From Date (mm/dd/yr):	To Date (mm/dd/yr):	Hrs./Wk. (40hrs/wk)	/Wk
Full- Time:	(check only one)	Part-Time:	(check only one)	Monthly Salary:
Your Title:	Immediate Supervisor:	Employer/Supervisor Phone Number:
Duties:
Machines / Equipment used:	Number and Title of people supervised:	Reason for leaving:
6. EMPLOYER NAME:	EMPLOYER LOCATION:
From Date (mm/dd/yr):	To Date (mm/dd/yr):	Hrs./Wk. (40hrs/wk)	/Wk
Full- Time:	(check only one)	Part-Time:	(check only one)	Monthly Salary:
Your Title:	Immediate Supervisor:	Employer/Supervisor Phone Number:
Duties:
Machines / Equipment used:	Number and Title of people supervised:	Reason for leaving:
I declare that any statement in this application or information provided is true and complete. I understand that if I provide false information it shall be sufficient cause for disqualification or dismissal. I attest that I have the legal right to reside and work in this country. (Proof required upon employment.) A record of conviction will not necessarily bar you from employment. The Hiring Authority will consider, in addition to the record of conviction, the factors such as: The length of time that has passed since the offense; The age of the applicant at the time of the offense; The severity and nature of the offense; The relationship of the offense to the position for which the applicant has applied; and Evidence of the rehabilitation of the applicant. In connection with this application, I authorize Washoe County and any agent acting on its behalf to conduct an inquiry into any information related to my potential or continued employment with the county and authorize the release of any such information, including, but not limited to, prior employers and any criminal conviction on my record. Moreover, I hereby release Washoe County and any agent acting on its behalf from any liability by reason of requesting such information from any person and its subsequent release as provided herein.
Signature (DO NOT PRINT):	Date:
List any other names that you have used:	Social Security Number:
Should more space be needed to list your employment history, ADDITIONAL employment history forms are available for your use. PLEASE REMEMBER TO KEEP A COPY OF YOUR APPLICATION WHEN COMPLETED. You may be asked to bring a copy of your current application to job interviews, and you may need it for future reference when applying for other positions. PLEASE ATTACH COPIES OF APPROPRIATE CERTIFICATIONS, LICENSES, AND/OR TRANSCRIPTS IF REQUESTED IN THE JOB ANNOUNCEMENT.

ADDITIONAL FORM - PLEASE LIST JOBS BEGINNING WITH THE MOST RECENT
7. EMPLOYER NAME:	EMPLOYER LOCATION:
From Date (mm/dd/yr):	To Date (mm/dd/yr):	Hrs./Wk. (40hrs/wk)	/Wk
Full- Time:	(check only one)	Part-Time:	(check only one)	Monthly Salary:
Your Title:	Immediate Supervisor:	Employer/Supervisor Phone Number:
Duties:
Machines / Equipment used:	Number and Title of people supervised:	Reason for leaving:
8. EMPLOYER NAME:	EMPLOYER LOCATION:
From Date (mm/dd/yr):	To Date (mm/dd/yr):	Hrs./Wk. (40hrs/wk)	/Wk
Full- Time:	(check only one)	Part-Time:	(check only one)	Monthly Salary:
Your Title:	Immediate Supervisor:	Employer/Supervisor Phone Number:
Duties:
Machines / Equipment used:	Number and Title of people supervised:	Reason for leaving:
9. EMPLOYER NAME:	EMPLOYER LOCATION:
From Date (mm/dd/yr):	To Date (mm/dd/yr):	Hrs./Wk. (40hrs/wk)	/Wk
Full- Time:	(check only one)	Part-Time:	(check only one)	Monthly Salary:
Your Title:	Immediate Supervisor:	Employer/Supervisor Phone Number:
Duties:
Machines / Equipment used:	Number and Title of people supervised:	Reason for leaving:
10. EMPLOYER NAME:	EMPLOYER LOCATION:
From Date (mm/dd/yr):	To Date (mm/dd/yr):	Hrs./Wk. (40hrs/wk)	/Wk
Full- Time:	(check only one)	Part-Time:	(check only one)	Monthly Salary:
Your Title:	Immediate Supervisor:	Employer/Supervisor Phone Number:
Duties:
Machines / Equipment used:	Number and Title of people supervised:	Reason for leaving:
APPLICANT NAME:	DATE:
SOCIAL SECURITY NUMBER:	TITLE OF POSITION WHICH YOU ARE APPLYING FOR: