CASCADE COUNTY
EMPLOYMENT APPLICATION
AN EQUAL OPPORTUNITY EMPLOYER
The information contained on this form is sought in good faith. It will not be used in any
way to discriminate against any applicant for employment in violation of state and federal
law. Published on June 7th, 2013.
For County Use
IMPORTANT: Please type or print in ink. You may respond to sections 4, 5, and 9 on separate sheets of paper if all relevant blocks are
completed and the same format is followed. On each sheet, write your name and the job title of the position(s) for which you are
applying. You may submit a legible photocopied application. If you photocopy your application, leave sections 1, 2, and 3 blank and
complete these sections each time you apply. You must sign and date, in ink, each application you submit. LATE, INCOMPLETE or
UNSIGNED applications will not be considered.
PLEASE READ THE JOB VACANCY ANNOUNCEMENT CAREFULLY TO FIND: (a) what attachments must be submitted (supplement
questions, transcript, Employment Preference Form, etc.); (b) where to submit your application; (c) the required special qualifications or
licenses; (d) the closing date for receipt of applications. An application tailored to the position is to your advantage.
Under state and federal law, qualified applicants with disabilities are entitled to reasonable accommodations. Modifications or
adjustments may be provided to assist applicants to compete in the recruitment and selection process, to perform the essential duties of
the job, or to enjoy equal benefits and privileges of employment available to other employees. An applicant must request an
accommodation when needed. A description of the selection process and the essential job duties is included in the vacancy
announcement.
Employment Preference: The Veterans' Employment Preference Act and the Persons with Disabilities Employment Preference Act
provide preference in public employment for certain military veterans and people with disabilities, or the eligible relatives thereof. An
applicant claiming employment preference must complete an Employment Preference Form, available through Human
Resources or your local Montana Job Service. The applicant must indicate at the bottom of page five (5) that the necessary
documentation is attached. Contact your local Montana Vocational Rehabilitation Services Office (Department of Public Health and
Human Services) for detail on obtaining disabilities preference certification. For more information, contact your local Job Service.
1.
Name:
Address:
Street
City State Zip Code
2.
What position are you applying for? (See Job Vacancy
Announcement.)
Department:
Closing Date of
Vacancy:
Phone Number:
Transcript DD-214 Resume DPHHS Certification
Other (specify)
Signature:
4.
Work Home Cell
My signature below certifies that all information on this and all attached pages (checked below) are true, correct and complete to
the best of my knowledge and contain no willful falsifications or misrepresentations. Falsifications or misrepresentations may
disqualify me from consideration for employment with Cascade County or, if hired, may be grounds for termination at a later date.
Employers may be contacted as references. In the spaces below, I have checked attachments, including those required in the job
vacancy announcement. I understand that, if I am the final applicant for the applied position, a criminal background check may be
conducted and the results thereof may disqualify me from consideration for employment with the County.
3.
Yes No
If yes, list on a separate sheet of paper the convictions.
Date:
Have you ever been convicted of a crime involving theft, abuse, neglect, or mistreatment of an individual or any other felony/
misdemeanor (except routine traffic violations)? A conviction will not necessarily disqualify you for the position.
Typing/Ten-key Certification
Last First M.I.
Responses to Supplemental Questions
Position:
