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All portions of this application must be completed in order for Northeast Nebraska Juvenile Services Center to consider employment.  This is not a secure site.  We will ask for Social Security number at time of interview.

~General Information~
Position(s) applied for:  
How did you learn about us?        If other:

Today's Date:

Phone:

Name:
Last First M.I.

City:

State

Zip

E-mail

~Education~
Name & Address of School

Graduate: Yes/No

Type Diploma/Degree

Major/Minor-Fields of Study

High School
College
Other (Graduate, Vocational, Military, etc.) Select your Highest Grade Completed

~Placement~

Best time to contact you:     May we contact you at work?  Yes No Work Phone

Have you ever filed an application with us before?   Yes No If so, give date

Have you ever been employed with us before?   Yes No   If so, give date  

Do any of your friends or relative, other than spouse, work here?  Yes No 

Are you currently employed?   Yes No 

When would you be available to begin work?  

Are you available for work:  

     

Shift/hours you are available for work: 

Are you currently on "lay-off" status and subject to recall?   Yes   No
Can you travel if a job requires it?   Yes   No
Can you relocate if a job requires it?   Yes   No
Are you able to meet the attendance requirements of the position?   Yes   No
Will you work overtime if required?  Yes   No

~Bonding~

Have you ever been convicted of a felony crime in the last seven (7) years? 

If yes, explain: 

~Employment History~
Give a complete record of all employment (including military service) and unemployment during the past 10 years.  List most recent employer:

May we contact your present employer?   Yes    No    May we contact your past employers?   Yes   No

Please complete the boxes with the following information:

Name & address of Company, Dates of Employment (start/finish), Type of Business & Work Duties, Salary per Hour, Reason for Leaving, Supervisor's Name, Phone Number.

~References~

List name and telephone number of three(3) business/work references who are not related to you and are not previous supervisors.  If not applicable, list three school or personal references who are not related to you.