Jobs

2. WARNING: If you are applying for a position with Emergency Communications (I.E. Dispatch) or the Sheriff's Office, please follow the specific instructions included with the job posting. This form does not contain all of the necessary elements for a successful application for those departments.

6. Basic Information

8. First Name*
9. Last Name*
11. Street Address*
13. City*
14. State*
15. Email Address*
17. Primary Contact Number*
18. Secondary Contact Number
20. Position Being Applied For*
22. Resume

    If available, please include your resume. Your resume, if included with your application, will be considered supplementary to the job experience information below and is NOT considered a substitute for the fields in that section being filled out.

23. Cover Letter

    If available, please attach a cover letter to your application.

27. Education

29. Highest Grade Completed*

    1. 1st Grade
    2. 2nd Grade
    3. 3rd Grade

    1. 4th Grade
    2. 5th Grade
    3. 6th Grade

    1. 7th Grade
    2. 8th Grade
    3. 9th Grade

    1. 10th Grade
    2. 11th Grade
    3. 12th Grade
31. High School Diploma or Equivalent*

    If you did not complete high-school, do you have a high-school equivalency diploma?

    1. Yes

    1. No

    1. I have a high-school diploma
33. Post High-School Education*

    Please identify the number of years of post high-school education you have.

    1. 1 Year
    2. 2 Years
    3. 3 Years

    1. 4 Years
    2. 5 Years
    3. 6 Years

    1. 7 Years
    2. More Than 7 Years
    3. None
35. Name of Institution*
37. Date Started*
    Date Started
38. Date Ended*
    Date Ended
39. Hours*
41. Degree Received*
43. Major or Specialty*
44. Minor
46. Do you need to add another educational institution?*

    1. Yes

    1. No
48. Name of Institution*
50. Date Started*
    Date Started
51. Date Ended*
    Date Ended
52. Hours*
54. Degree Received*
56. Major or Specialty*
57. Minor
59. Do you need to add another educational institution?*

    1. Yes
    2. No
61. Name of Institution*
63. Date Started*
    Date Started
64. Date Ended*
    Date Ended
65. Hours*
67. Degree Received*
69. Major or Specialty*
70. Minor

74. Job Experience

    Starting with the most recent, describe ALL paid, military, and applicable voluntary experience. Highlight your knowledge, skills, and abilities which best demonstrate your qualifications for this position. You may list significantly different jobs within the same organization as separate items.

76. Job Title*
77. Employer*
79. Employer Address*
80. Type of Business*
82. Immediate Supervisor*
83. Supervisor's Title*
85. Starting Salary*
86. Final Salary*
87. Hours Per Week*
89. Start Date*
    Start Date
90. End Date*
    End Date
91. Type*

    1. Full-Time

    1. Part-Time
93. Duties*

    Please list all of the duties performed for this position. For multiple duties, please enter each on a separate line.

95. Number of Employees Supervised*
96. Titles of Employees Supervised
98. Equipment Used
99. Reason for Leaving*
101. Your Name if Different Than Present
103. Contact Employer*

     Please indicate if we may contact your supervisor with regards to this position.

     1. Yes

     1. No
104. Supervisor Contact Number*
106. Do you need to add another job?*

     1. Yes
     2. No
108. Job Title*
109. Employer*
111. Employer Address*
112. Type of Business*
114. Immediate Supervisor*
115. Supervisor's Title*
117. Starting Salary*
118. Final Salary*
119. Hours Per Week*
121. Start Date*
     Start Date
122. End Date*
     End Date
123. Type*

     1. Full-Time

     1. Part-Time
125. Duties*

     Please list all of the duties performed for this position. For multiple duties, please enter each on a separate line.

127. Number of Employees Supervised*
128. Titles of Employees Supervised
130. Equipment Used
131. Reason for Leaving*
133. Your Name if Different Than Present
135. Contact Employer*

     Please indicate if we may contact your supervisor with regards to this position.

     1. Yes

     1. No
136. Supervisor Contact Number*
138. Do you need to add another job?*

     1. Yes
     2. No
140. Job Title*
141. Employer*
143. Employer Address*
144. Type of Business*
146. Immediate Supervisor*
147. Supervisor's Title*
149. Starting Salary*
150. Final Salary*
151. Hours Per Week*
153. Start Date*
     Start Date
154. End Date*
     End Date
155. Type*

     1. Full-Time

     1. Part-Time
157. Duties*

     Please list all of the duties performed for this position. For multiple duties, please enter each on a separate line.

159. Number of Employees Supervised*
160. Titles of Employees Supervised
162. Equipment Used
163. Reason for Leaving*
165. Your Name if Different Than Present
167. Contact Employer*

     Please indicate if we may contact your supervisor with regards to this position.

     1. Yes

     1. No
168. Supervisor Contact Number*
170. Do you need to add another job?*

     1. Yes
     2. No
172. Job Title*
173. Employer*
175. Employer Address*
176. Type of Business*
178. Immediate Supervisor*
179. Supervisor's Title*
181. Starting Salary*
182. Final Salary*
183. Hours Per Week*
185. Start Date*
     Start Date
186. End Date*
     End Date
187. Type*

     1. Full-Time

     1. Part-Time
189. Duties*

     Please list all of the duties performed for this position. For multiple duties, please enter each on a separate line.

191. Number of Employees Supervised*
192. Titles of Employees Supervised
194. Equipment Used
195. Reason for Leaving*
197. Your Name if Different Than Present
199. Contact Employer*

     Please indicate if we may contact your supervisor with regards to this position.

     1. Yes

     1. No
200. Supervisor Contact Number*
202. Do you need to add another job?*

     1. Yes
     2. No
204. Job Title*
205. Employer*
207. Employer Address*
208. Type of Business*
210. Immediate Supervisor*
211. Supervisor's Title*
213. Starting Salary*
214. Final Salary*
215. Hours Per Week*
217. Start Date*
     Start Date
218. End Date*
     End Date
219. Type*

     1. Full-Time

     1. Part-Time
221. Duties*

     Please list all of the duties performed for this position. For multiple duties, please enter each on a separate line.

223. Number of Employees Supervised*
224. Titles of Employees Supervised
226. Equipment Used
227. Reason for Leaving*
229. Your Name if Different Than Present
231. Contact Employer*

     Please indicate if we may contact your supervisor with regards to this position.

     1. Yes

     1. No
232. Supervisor Contact Number*
234. Licenses, Certificates, and Other Authorizations

     Please list any licenses (including driver's), certificates, or other authorizations to practice a trade or profession. If applicable, please indicate your license number and the licensing board that granted said license.

236. Additional Information

     Please use this space for any additional information you think would help us evaluate your application, including training, seminars, workshops, and special achievements, or specialized skills.

240. References

242. Name of Reference*
244. Address*
246. Contact Number*
247. Relationship*
251. Name of Reference
253. Address
255. Contact Number
256. Relationship
260. Name of Reference
262. Address
264. Contact Number
265. Relationship

269. Miscellaneous

271. Shifts*

     Please check which shift(s) you will accept:

     1. Day
     2. Evening

     1. Night
     2. Rotating

     1. Weekends
273. Job Status*

     Please indicate which employment status you would accept:

     1. Full-Time

     1. Part-Time
274. Employment Status*

     Please check which employment status you would accept:

     1. Salaried (Benefits)
     2. Hourly (No Benefits)

     1. Part-Time (No Benefits)
276. Travel*

     Are you willing to accept employment that requires you to travel? Please check all that apply.

     1. Yes
     2. No
     3. If "Yes", during the day only

     1. Occasionally Overnight
     2. Frequently Overnight
278. Transportation*

     Are you willing to provide your own transportation if necessary for your employment?

     1. Yes

     1. No
280. Immigration & Reform Act*

     For purposes of compliance with the Immigration Reform and Control Act, are you legally eligible for employment in the United States? Under the Immigration Reform and Control Act of 1986, you will be required to fill out a certification verifying that you are eligible to be employed and verifying your identity. Further, you will be required to provide documentation to that effect should you be employed.

     1. Yes

     1. No
282. Service in the Armed Forces*

     For purposes of compliance with Section 2.1-112 of the Code of Virginia, have you ever served in the Armed Forces of the United States during the following dates? (Please check all that apply)

     1. World War I (04/16/1917 to 04/01/1920)
     2. World War II (12/07/1941 to 12/31/1946)
     3. Korean Conflict (06/27/1950 to 01/31/1955)

     1. Vietnam Conflict (08/05/1964 to 03/07/1975)
     2. None of the dates shown, but I did serve in the military.
     3. I have not served in the military.
284. Criminal Convictions*

     Have you ever been convicted of a crime or law enforcement violation?

     1. Yes

     1. No
286. Availablity*
     Availablity

     When will you be available to start work? (No date is necessary if you are available as soon as you give two (2) weeks notice.)

288. Additional Comments

     Do you have comments or any additional information that you would like to make known on your application for this position?

290. Digital Signature*

     I hereby certify that all entries and attachments are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part to any employment in the service of the County of Madison, Virginia. I understand that all information on this application is subject to verification. I also consent to references and former employees and educational institutionalized being contacted regarding this application. I further authorize the County of Madison, Virginia to rely upon and use, as It sees fit, any information received from such contacts. Information contained on this application may be disseminated to other agencies, nongovernmental organizations, or systems on a need-to-know basis for good cause shown as determined by the agency head or designee.

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