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Employment Application Form. This is a Nevada form and can be use in Administrative Office Of The Courts Statewide.
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Tags: Employment Application, Nevada Statewide, Administrative Office Of The Courts
SUPREME COURT OF NEVADA
EMPLOYMENT APPLICATION
Supreme Court Personnel Office, 201 S. Carson Street, Suite 250, Carson City, Nevada 89701-4702
Phone (775) 684-1700 Fax (775) 684-1723 TDD (775) 684-1665
IMPORTANT: READ INSTRUCTIONS ON THIS PAGE BEFORE COMPLETING THE APPLICATION.
Please type or print clearly in blue or black ink
INSTRUCTIONS FOR COMPLETING THE SUPREME COURT OF NEVADA EMPLOYMENT APPLICATION:
A.
Complete a separate application for each position. Photocopies are acceptable provided each has
an original signature, correct position title, and correct position number. Submit a resume and cover
letter as an attachment to this application.
B.
Do not refer to resume in lieu of completing all sections of application.
C.
Applications are accepted and processed only for positions for which recruitment is currently being
conducted.
D.
Applications received after closing date of a position will not be processed.
E.
This application form and its attachments are official property of the Supreme Court of Nevada and
will not be returned, reused, or copied after being processed. You should retain a copy of this
application for future use or reference.
The Supreme Court of Nevada is an at-will employer. Employees of the Nevada Supreme Court or its departments
are either unclassified or non-classified personnel. As such, they are at-will employees, i.e., working at the
pleasure of the court. No implied contract exists pertaining to the continuation of employment with the Court.
Employment with the court is voluntarily entered into, and the employee is free to resign with or without cause.
Similarly, the Court may terminate the employment relationship at will at any time, with or without cause.
Position for which you are applying: _________________________________ Position Number: _____________
Department (e.g., AOC, Clerk’s Office): ______________________________ Salary Expected: _____________
Applicant Name:__________________________________________________ Date: _______________________
HOW DID YOU HEAR ABOUT THIS POSITION? (Check all that apply)
Nevada Supreme Court Website
State of Nevada Dept. of Personnel
Friend / Relative
Rev. 7/07
Classified Advertisement (Please Specify)____________________
Other (please specify)_____________________________________
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Last Name: _______________________________________ First Name: _______________________________________ MI: ________
Street Address: ___________________________________________________________________________________________________
Address
City
State
Zip
Mailing Address: __________________________________________________________________________________________________
Address
City
State
Zip
E-mail Address: _____________________________________________
Home Phone: (_____) ____________________
Work Phone: (____) ________________
Message Phone: (____) ______________________
Cell Phone: (____) _________________
Message Contact: _____________________________________________________
Name
May we contact you at all of the phone numbers listed above?
Type of appointment Desired: (Check all that apply)
Temporary:
Part-time
Part-time
No Do not contact me at: _________________________
Work Location Preferences:
Full-time
Regular:
Yes
Address
Carson City
Las Vegas
Full-time
Other: __________________________________________
If considerable out-of-town travel is required, would you be willing to travel?
Yes
Will you accept a job that requires you to work overtime, including weekends or holidays?
No
Yes
No
Shifts you are able to work:
Day
Night
Evening
Weekends
Alternate/Flex
Rotating
All
If hired, on what date can you start working? : __________________________________
If you possess a valid driver’s license, complete the following:
Driver’s License #: ________________________________ State:_________ Class: ________ Expiration Date:____________________
Are you presently eligible to work in the United State?
Yes
No
(Applicants will be required to furnish proof of identity and legal right to work in the united States)
Are you over 18 years of age?
Rev. 7/07
Yes
No
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Do you have relatives working for the Supreme Court of Nevada?
Yes
No
If yes, list their name(s), name of department in which employed, and their relationship to you:
________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Do you have current of previous employment with the Supreme Court of Nevada or any other public employer/branch of Nevada
State Government?
Current Employee
Former Employee
Never been employed by the Court/other public employer
If a current of former employee with the Supreme Court of Nevada or any other public employer/branch of Nevada State
Government, complete the following: Attach additional sheets as necessary.
Date employed from: ____________ to: ____________
Job Title: _______________________________________________________
Employer’s name: _______________________________________________ Division/Dept.: _____________________________________
Are you currently serving a probationary period?
Yes
No
*********************************************************************************************
Date employed from: ____________ to: ____________
Job Title: _______________________________________________________
Employer’s name: _______________________________________________ Division/Dept.: _____________________________________
Are you currently serving a probationary period?
Yes
No
High School Attended: ________________________________________ City/State___________________________________________
Do you possess?
High School Diploma
G.E.D. Certificate
High School Proficiency
Highest Grade Completed _________________ Please provide copies of Diplomas, transcripts, Certificates and/or Degrees received.
Credit Hours Completed
College Name & Location
Semester
Quarter
Major
Type of Degree
Degree Awarded?
Yes
Yes
Course of Study
# Weeks Attended
# Hours / Week
No
Yes
Business, Vocational, Professional or Technical School
No
No
Program Completed ?
Yes
Yes
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No
No
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Job related licenses, registrations, certifications, and professional memberships:
Name of license, registration & /or certification
Type
Number
State Issued
Expiration Date
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Are you proficient in a language other than English?
Yes
No
If yes, complete the following:
Languages
Can Speak / Understand?
Can Translate?
Can Read?
Can Write?
Fluently
Passably
Into English
From English
Easily
With Difficulty
__ Easily
With Difficulty
Fluently
Passably
Into English
From English
Easily
With Difficulty
Easily
With Difficulty
Skills – List the following skills, experience, etc. which you have:
Word Processing / Desktop Publishing software (i.e. Word, InDesign, etc.):_____________________________________________________
_________________________________________________________________________________________________________________
Presentation Software: ______________________________________________________________________________________________
_________________________________________________________________________________________________________________
Accounting Software: _______________________________________________________________________________________________
_________________________________________________________________________________________________________________
Computer Software (i.e. spreadsheets, databases, etc.): _____________________________________________________________________
_________________________________________________________________________________________________________________
Computer Hardware: ________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Legal Research: ____________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Typing (specify wpm ________) Other: ________________________________________________________________________________
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List useful, work related experiences, qualifications, or skills that relate to the position for which you are applying.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Have you been fired, terminated, or requested to resign (instead of termination) from any position on the past fifteen (15) years?
Yes
No
(If yes, please identify the name of the employer and explain the circumstances surrounding the severance of your employment relationship)
________________________________________________________________________________________________________________
EMPLOYMENT HISTORY: Beginning with your current or most recent employer (including self-employment experience) list your work
record for the last 15 years. List jobs held prior to 15 years ago if they relate to the position you are applying. If more than one position has
been held with the same organization list each separately. Attach additional sheets as necessary. Complete each section: Do not refer to
resume.
Current or Last Employer: _______________________________________________ Phone Number:(_____)________________
Address / City / State / Zip:________________________________________________________________________________
From: _________ To: __________
Check One:
Full-time
Part-time
Hours per week:______________________
Supervisor's Name:_____________________________________ Supervisor's Job Title:________________________________
Your Title: ______________________________________________Starting Salary:___________ Ending Salary:______________
Did you supervise other employees?
Yes
No
Number of employees supervised by you: ________________________
Duties (be specific):______________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Reason for leaving: ______________________________________________________________________________________
_________________________________________________________________________________________________________________
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Current or Last Employer: _______________________________________________ Phone Number:(_____)________________
Address / City / State / Zip:________________________________________________________________________________
From: _________ To: __________
Check One:
Full-time
Part-time
Hours per week:______________________
Supervisor's Name:_____________________________________ Supervisor's Job Title:________________________________
Your Title: ______________________________________________Starting Salary:___________ Ending Salary:______________
Did you supervise other employees?
Yes
No
Number of employees supervised by you: ________________________
Duties (be specific):______________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Reason for leaving: ______________________________________________________________________________________
_________________________________________________________________________________________________________________
Current or Last Employer: _______________________________________________ Phone Number:(_____)________________
Address / City / State / Zip:________________________________________________________________________________
From: _________ To: __________
Check One:
Full-time
Part-time
Hours per week:______________________
Supervisor's Name:_____________________________________ Supervisor's Job Title:________________________________
Your Title: ______________________________________________Starting Salary:___________ Ending Salary:______________
Did you supervise other employees?
Yes
No
Number of employees supervised by you: ________________________
Duties (be specific):______________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Reason for leaving: ______________________________________________________________________________________
_________________________________________________________________________________________________________________
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Current or Last Employer: _______________________________________________ Phone Number:(_____)________________
Address / City / State / Zip:________________________________________________________________________________
From: _________ To: __________
Check One:
Full-time
Part-time
Hours per week:______________________
Supervisor's Name:_____________________________________ Supervisor's Job Title:________________________________
Your Title: ______________________________________________Starting Salary:___________ Ending Salary:______________
Did you supervise other employees?
No
Yes
Number of employees supervised by you: ________________________
Duties (be specific):______________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Reason for leaving: ______________________________________________________________________________________
_________________________________________________________________________________________________________________
Current or Last Employer: _______________________________________________ Phone Number:(_____)________________
Address / City / State / Zip:________________________________________________________________________________
From: _________ To: __________
Check One:
Full-time
Part-time
Hours per week:______________________
Supervisor's Name:_____________________________________ Supervisor's Job Title:________________________________
Your Title: ______________________________________________Starting Salary:___________ Ending Salary:______________
Did you supervise other employees?
Yes
No
Number of employees supervised by you: ________________________
Duties (be specific):______________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Reason for leaving: ______________________________________________________________________________________
_________________________________________________________________________________________________________________
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Current or Last Employer: __________________________________________ Phone Number:(_____)_________________
Address / City / State / Zip: ________________________________________________________________________________
From: _________ To: __________ Check One:
Full-time
Part-time Hours per week:______________________
Supervisor's Name:_____________________________________ Supervisor's Job Title:______________________________
Your Title: __________________________________________ Starting Salary:___________ Ending Salary:_____________
Did you supervise other employees?
Yes
No Number of employees supervised by you: ______________________
Duties (be specific):_________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
_______________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Reason for leaving: ________________________________________________________________________________________________
_________________________________________________________________________________________________________________
May we contact all employers/supervisors listed to determine that you meet the qualifications listed for the position that you have
applied?
Yes
No
If no, indicate exceptions and explain: ______________________________________________________________
Did you complete this application yourself?
Yes
No
If not, who did? __________________________________________
Professional References:
List three (3) people who are not related to you who know your qualifications and fitness for the job which you are applying.
Full Name of Reference
Present Business or Home Address
Telephone Number(s)
Business/Occupation
1. _______________________________________________________________________________________________________________
2. _______________________________________________________________________________________________________________
3. _______________________________________________________________________________________________________________
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Have you ever been convicted of any violation of the law other than moving traffic violations?
Yes
No
(You must answer yes if you have any convictions, in any state, no matter how long ago, whether felony or misdemeanor, even
if they have been set aside, vacated, pardoned, expunged, dismissed or appealed, whether or not your civil rights were restored,
you successfully completed probation, went to trial, entered a guilty plea or a no contest plea. Convictions will be evaluated
in relation to the particular position you are applying for and will not necessarily disqualify you for employment. )
If yes, please explain as accurately and completely as possible. Providing false or incomplete information may result in the rejection
of your application.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Signature, Certification and Release of Information
I hereby certify that the facts set forth on this application are true and complete and I understand that any misrepresentation, falsification, or
willful omission herein shall be sufficient reason for dismissal or refusal of employment.
I authorize the Supreme Court of Nevada (hereinafter "Court"), and any agent acting on its behalf, to conduct an inquiry into any information
related to my potential or continued employment with the Court and authorize the release of any such information, including but not limited
to, any criminal conviction on my record. I hereby release from liability the Court and its agents acting on its behalf for seeking, gathering,
and using such information as may be allowed by law, and all other persons, employers, corporations or organizations for furnishing such
information. I recognize that any and all inquiries made by the Court and any agents acting on its behalf and any and all verbal or written
statements gathered there from shall remain solely the property of the Court.
I also understand that, if accepted for employment, I shall be required to provide proof of identity and eligibility to work in the United States
in compliance with the Immigration Reform and Control Act of 1986, as amended, as a condition of receiving any compensation from the
Court.
I understand that my initial and/or continued employment with the Court is contingent upon successfully passing a mandatory fingerprinting,
employment history check, and criminal background investigation. I understand that the terms of my employment, including working
conditions, compensation, benefits, hours of work, work schedule, job assignment, and location will be determined and/or changed within the
discretion of the Court and pursuant to applicable policies.
The Supreme Court of Nevada is an at-will employer. Employees of the Nevada Supreme Court or its departments are either unclassified or
non-classified personnel. As such, they are at-will employees, i.e., working at the pleasure of the court. No implied contract exists
pertaining to the continuation of employment with the Court. Employment with the Court is voluntarily entered into, and the employee is
free to resign at will at any time, with or without cause. Similarly, the court may terminate the employment relationship at will at any time,
with or without notice or cause.
Signature: (Do not print):_______________________________________________________________ Date:_____________________
The Supreme Court of Nevada is an equal employment opportunity employer. We adhere to a policy of making employment decisions
without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your
opportunity for employment with the Court depends solely on your qualifications.
Thank you for completing this application and for your interest in employment with the Court.
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CONFIDENTIAL DATA FORM
Completion of this form is strictly voluntary. Therefore, a decision not to complete the form will have no effect upon your application for
employment.
To comply with Federal, State and local guidelines in equal employment practices, the Supreme Court of Nevada must gather information
and maintain records on application flow, and recruitment sources. Neither this form nor the information you provide will be used for any
other purpose not required by Federal, State and local guidelines.
POSITION APPLYING FOR: ____________________________________________________
GENDER:
Male
VETERAN STATUS:
Female (please circle one)
POSITION NUMBER: _______________
AGE over 40? : YES
Are you a Veteran?
YES
NO
(please circle one)
Disabled Veteran?
YES
NO
(please circle one)
Vietnam Era Veteran?
YES
NO
(please circle one)
Desert Storm / Shield Veteran
YES
NO
NO (please circle one)
(please circle one)
DISABILTIY IDENTIFICATION: Anyone with a physical or mental impairment substantially limiting one or
more major life activities; has a record of such impairment; or is regarded as having such an impairment, is
considered a person with a disability. Major life activities means functions such as caring for one’s self, performing
manual tasks, walking, seeing, hearing, speaking, breathing, learning and working. In terms of employment, the law
defines a “qualified individual with a disability” as a person with a disability who can perform the essential functions
of the job with or without reasonable accommodation.
Do you need any accommodation with any special needs? YES
ETHNIC IDENTIFICATION:
NO (please circle one)
(Circle one)
White
Persons having origins in any of the original peoples of Europe or the Middle East.
Black
Persons having origins in any of the black racial groups of Africa.
Hispanic
Persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture
or origin.
Native American
/Alaskan Native
Persons having origins in any of the original peoples of North America, and who maintain
cultural identification through tribal affiliation or community recognition.
Asian
/Pacific Islanders
Persons having origins in any of the original people of the Far East, Southeast, Asia, Indian
subcontinent, or the Pacific Islands.
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