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)_____________________________________ Page 1 American LegalNet, Inc. www.FormsWorkflow.com 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 Page 2 American LegalNet, Inc. www.FormsWorkflow.com 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 Rev. 7/07 No No Page 3 American LegalNet, Inc. www.FormsWorkflow.com 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: ________________________________________________________________________________ Rev. 7/07 Page 4 American LegalNet, Inc. www.FormsWorkflow.com 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: ______________________________________________________________________________________ _________________________________________________________________________________________________________________ Rev. 7/07 Page 5 American LegalNet, Inc. www.FormsWorkflow.com 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: ______________________________________________________________________________________ _________________________________________________________________________________________________________________ Rev. 7/07 Page 6 American LegalNet, Inc. www.FormsWorkflow.com 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: ______________________________________________________________________________________ _________________________________________________________________________________________________________________ Rev. 7/07 Page 7 American LegalNet, Inc. www.FormsWorkflow.com 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. _______________________________________________________________________________________________________________ Rev. 7/07 Page 8 American LegalNet, Inc. www.FormsWorkflow.com 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. Rev. 7/07 Page 9 American LegalNet, Inc. www.FormsWorkflow.com 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. Rev. 7/07 Page 10 American LegalNet, Inc. www.FormsWorkflow.com