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GILA COUNTY

1400 E Ash Street

Globe, Arizona 85501

(928) 425-3231 TDD: 7-1-1 Fax (928) 402-4252

AN EQUAL OPPORTUNITY EMPLOYER

Dear Ap

plicant:

Please read the following instructions before filling out the online application.

 The online application uses Adobe Reader; the latest version of Adobe Reader is needed to complete the

application. The latest version of Adobe Reader can be found at http://get.adobe.com/reader/. Mac users

please note which program is opening the application, if it is not Adobe Reader, there will be issues with

saving the completed application.

 Before completing the application, verify that data typed in the application can be saved. If the

application is unable to be saved, the application can be printed and mailed to Gila County Human

Resources, 1400 E. Ash St., Globe, AZ 85501 or fax to (928)402-4252.

Sending your application online

 Complete the application.

 There is no need to sign this document using Adobe’s signature tool.

 Select the save button at the top of the application. It will take you to the Employee Application

Agreement (pg.9). Please read the Agreement thoroughly.

 By accepting the terms of the agreement the application is now enabled to be sent via email. Please note

that clicking the “Yes, I Accept” is a binding form of your electronic signature.

 In order to send the application through email, save the application to a location on your computer. After

saving the application, open your email, compose a new message and attach the application. Send the

application to employment@gilacountyaz.gov.

 If the application was successfully received, an automatic reply email will be sent. If you do not receive

this automatic reply email, check your sent items to ensure that your application was successfully sent.

Please note that if you are applying for multiple positions within the same day, you may only receive

one automated response. If you would like to confirm receipt of your application, please feel free to

email employment@gilacountyaz.gov or call at the number listed below.

If you are having difficulties submitting your application online, please contact Human Resources at (928)402-

4361 or by email, employment@gilacountyaz.gov.

GilaCounty‐StateofArizonaEmploymentApplication Page1of6

GILA COUNTY

1400 E Ash Street

Globe, Arizona 85501

(928) 425-3231 TDD: 7-1-1 Fax (928) 402-4252

AN EQUAL OPPORTUNITY EMPLOYER

EMPLOYMENT APPLICATION

POSITION FOR WHICH YOU ARE APPLYING:

(See Job Announcement)

PositionTitle:_____________________________________________________________________________________________

JobCode: ___________________________ Department/Location:__________________________________________

PERSONAL:

Name:____________________________________________________________________________________________________

Last    First    Middle

MailingAddress:_____________________________________________________________________________________________

City:___________________________ State:_________________ Zip:_________________________

TelephoneNumber(s):___________________________________________E‐mail:___________________________________

ADDITIONAL INFORMATION:

Isthereanyadditionalinformationrelativetochangeofname,useofanassumednameornicknamenecessarytopermitacheckon

yourworkandeducationrecords?‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Yes  No

IfYes,pleasee

xplain:_________________________________________________________________________________

Areyouprese

ntlyaGilaCountyemployeewithRegularStatus?‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Yes No

Othertha

nEnglish,doyoufluentlyspeak:‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Spanish Other N/A

Ifother

,pleasespecify:____________________________________________________

Ifapplicable,doyo

upossessavalidArizonaDriverLicense?‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Yes No

Haveyo

ueverbeenconvictedofafelonyoffense?‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Yes No

IfYes,Pleaseprovid

efurtherinformation:__________________________________________________________________

_______

___________________________________________________________

Areyoulegallyeligibleforem

ploymentintheUnitedStatesofAmerica?‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Yes No

(proofofcitizenshiporimmigrationstatuswillberequireduponemployment)

AVAILABILITY:

Willyouaccept(checkallthatapply): FullTime PartTime Temporary Seasonal(intermittent)

ShiftsAvailabletowork: Day Evening Night Rotating

Willyouworkweekendsorholidaysifrequired?‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Yes No

Ifoutoftowntravelisrequired,wouldyoubewillingandabletotravel?‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Yes No

GilaCounty‐StateofArizonaEmploymentApplication

Page2of6

EMPLOYMENT HISTORY:

Beginwithmostrecentjobfirst.Filloutjobexperienceindetail.Includepaidorverifiablenon‐paidexperienceincludingMilitary

Service.Ifyouhavehadmorethanonepositionwiththesameemployer,pleaselisteachpositionseparately.Providecompleteand

accurateaddressesofformeremployers.Includeareacodeandphonenu

mber.Attachadditionalpagesifnecessary

CompanyName:_____________________________________________ Phone:____________________________________

Address:

____________________________________ From:________________To:________________

JobTitle:

_____________________________StartingSalary:________________EndingSalary:________________

NameandTitleofSupervisor:

___________________________________________________________

ReasonforLeaving:

_________________________________________________________________

Responsibilities:

Ifpresentlyemployed,maywecontactyourpresentemployer?‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Yes No

CompanyName:__________

___________________________________ Phone:____________________________________

Address:

____________________________________ From:________________To:________________

JobTitle:

_____________________________StartingSalary:________________EndingSalary:________________

NameandTitleofSupervisor:

___________________________________________________________

ReasonforLeaving:

_________________________________________________________________

Responsibilities:

CompanyName:__________

___________________________________ Phone:____________________________________

Address:

____________________________________ From:________________To:________________

JobTitle:

_____________________________StartingSalary:________________EndingSalary:________________

NameandTitleofSupervisor:

___________________________________________________________

ReasonforLeaving:

_________________________________________________________________

Responsibilities:

GilaCounty‐StateofArizonaEmploymentApplication

Page3of6

EMPLOYMENT HISTORY CONTINUED:

CompanyName:__________

___________________________________ Phone:____________________________________

Address:

_______________________________________ From:________________To:________________

JobTitle:

_____________________________StartingSalary:________________EndingSalary:________________

NameandTitleofSupervisor:

___________________________________________________________

ReasonforLeaving:

_________________________________________________________________

Responsibilities:

CompanyName:__________

___________________________________ Phone:____________________________________

Address:

_______________________________________ From:________________To:________________

JobTitle:

_____________________________StartingSalary:________________EndingSalary:________________

NameandTitleofSupervisor:

___________________________________________________________

ReasonforLeaving:

_________________________________________________________________

Responsibilities:

EDUCATION AND ADDITIONAL INFORMATION:

EDUCATION

High

School:__________________________________________ Address:__________________________________________

YesNo YesNo

Didyougraduate? Ifno,doyouhaveaGED? GEDInstitute:______________________________

Undergraduate

College: ________________________________________ Address:__________________________________________

YesNo

Didyougraduate? Degree:______________Major/SubjectsofStudy:_________________________________

Graduate

College:____________________________________________ Address:__________________________________________

YesNo

Didyougraduate? Degree

______________Major/SubjectsofStudy:_________________________________

Other:__________________________________________ Address:__________________________________________

YesNo

Didyougraduate? Degree:______________Major/SubjectsofStudy:_________________________________

GilaCounty‐StateofArizonaEmploymentApplication

Page4of6

Useth

espacebelowtolistProfessionalSocietyMemberships,jobrelatedlicenses,registrations,certificateswiththeirnumbers

andexpirationdates.

____________________________________________________________________________________________________________

TYPING:

None Lessthan30wpm 30‐39wpm 40‐44wpm 45‐50wpm

51‐60wpm 61‐70wpm 71‐ormorewpm

Please Read and Sign Below

Applicantsmayrequestanyneededaccommodationtoparticipateintheapplicationprocess.

____________________________________________

GilaCountydoesnotdiscriminateonthebasisofrace,color,nationalorigin,sex,religion,

ageordisabilityinemploymentortheprovisionofservices.

____________________________________________

STATEMENTOFCERTIFICATION‐APPLICANTSIGNATURE

By signing this application, I certify under penalty of law that the information provided anywhere in this

applicationistrue,correctandcomplete tothebestofmyknowledgeandbelief.IalsoauthorizeGilaCounty

tomakeallnecessaryandappropriateinvestigationsallowablebylawtoverifytheinformationprovided.

__________________________________________________ ______________________________

APPLICANT’SSIGNATURE

 

DATE

ALLAPPLICATIONSMUSTBESUBMITTEDTOTHEGILACOUNTY

HUMANRESOURCESDEPARTMENTTOBECONSIDEREDFOREMPLOYMENT

DONOTWRITEINTHISSPACE FOROFFICEUSEONLY

ReferenceCheck

□

Yes



□

No ClericalVerification/Testing



□

Yes

□

No

INTERVIEW

□

Yes



□

No Date:___________________________Time:________________________

ResultofInterview:____________________________________________________________________________________________

________

____________________________________________________________________________________

StartDate:____________________ Position:______________________________ Salary:______________________

Gila County Human Resources Department

Background Authorization

I hereby give Gila County Human Resources the right to make a thorough investigation of

my background including:

•

Criminal Record

•

Driving Record

•

Personal References

•

Social Media

•

Past Employment/Volunteer Status

•

Educational/Professional Status

•

Credit Check

And any other persons or sources as appropriate for the position for which I have expressed an

interest.

I release from liability all persons, companies, and corporations supplying such information and

indemnify and hold harmless Gila County from any liability which might result from such an

investigation.

I understand that I do not have to agree to this background check, but that refusal to do so may

exclude me from consideration.

I understand that information collected during this background check will be limited to that

appropriate to determine my suitability for certain positions and that all such information

collected during the check will be kept confidential.

I hereby extend my permission to those individuals or organizations contacted, for the purpose of

this background check, to give their full and honest evaluation of my suitability for the described

position and such other information, as they deem appropriate.

Signed:______________________________________Date: __________________________

Name: ______________________________________________________________________

Previous name(s)/alias:___________________________________________________________

DOB: ____/____/_________ Social Security #________-_____-___________

Driver’s License # __________________________________ State issued: __________________

Page 5 of 6

GilaCounty‐StateofArizonaEmploymentApplication

Page6of6

Governmentrequestedapplicantinformation.Thefollowingquestionsareforstatistical

purposesonly.Thispagewillbedetachedfromyourapplicationpriortoprocessing.

_______________________________ ________________________

ApplicantName PositionAppliedfor

1. Sex:

□

Female

□

Male

2. Birthday:_________________

3. EthnicCategory:

□

AmericanIndian

□

Asian

□

Black

□

Hispanic

□

White

4. StatutoryPreference:

□

Veteran’sPreference.

Youmustsubmitwithyourapplication,dependingonthebasisforpreferenceasshownbelow.Acopy

ofyourDD214orverificationcertificate.Pleasewriteyoursocialsecuritynumberontheform

submitted.Ifyousubmittedtheappropriateformwithinthelast12months,youneednotprovide

another.

BasisforPreference:

□

USActiveDutyServiceofmorethan180dayswithotherthandishonorabledischarge.

SubmitDD214.Datesofactivedutyservicefrom____________to____________

□

Serviceconnecteddisability.

Submitverificationcertificate(availableattheDepartmentofEconomicSecurityVeteransAffairs

office).

□

SpouseofveteranwhoisMIA,POW,totallyandpermanentlyserviceconnecteddisabled,orwho

diesofaserviceconnecteddisability.

Submitverificationcertificate(availableattheDepartmentofEconomicSecurityVeteransAffairs

office).

GILA COUNTY DRUG-FREE WORKPLACE POLICY

Gila County is committed to providing a safe, healthy and accident free workplace.

One of the conditions to achieving such an environment is that it be drug and alcohol

free. Therefore, In compliance with the Federal Drug Free Workplace Act of 1988,

other federal and state mandates, and in accordance with the County’s own precepts

and philosophy, Gila County hereby establishes this policy.

Under this policy the following activities are prohibited:

1. Reporting to work under the influence of a prohibited drug or under the influence

of alcohol.

2. The use, consumption, sale, purchase, transfer, or possession of any prohibited

drug by any employee during working hours, while on work assignments, or on

County premises; and

3. The consumption of alcohol by any employee during work hours, while on work

assignments or on County premises.

NOTE: For purpose of this policy, prohibited drugs include but are not limited to:

1. marijuana,

2. cocaine,

3. cocaine derivatives,

4. opiates (narcotics),

5. phencyclidine (PCP), and

6. amphetamines.

Further, it is a condition of County employment that employees agree to abide by the

terms of this policy and to notify Human Resources of any drug statute conviction no

later than five (5) days after such conviction. Every possible effort shall be expended

to hold such information in confidence with the County, but such information may be

required to be reported to a state of federal agency if a grant or contract funding for

the position is involved, or as otherwise required by law or regulation.

The county will deal firmly and fairly with any employee who violates this

policy. Violators are subjected to disciplinary action, which may include suspension

with or without pay, demotion, or termination. Sanctions may also include, but are not

limited to, a requirement that an employee participate in and successfully complete a

drug and/or alcohol abuse assistance or rehabilitation program at the employee’s own

expense.

The use of legally prescribed and over-the-counter medications is excluded from this

policy. However, such use is permitted only to the extent that the use of such

medication does not adversely affect the employee’s ability to work, job performance,

or the safety of the employee or others. The use of prescribed medications must be

under the direction of a licensed physician. Employees are required to report such

use to their supervisor.

Employee Application Agreement

Please read the following Employee Application Agreement ("Agreement") carefully before

electronically submitting your application for employment with Gila County.

BY CLICKING "YES I ACCEPT" BELOW, YOU ARE AGREEING TO THE TERMS AND

CONDITIONS OF THIS AGREEMENT. IF YOU DO NOT AGREE, YOU SHOULD CLICK "NO, I

REFUSE" AND YOU WILL NOT BE PERMITTED TO SUBMIT YOUR APPLICATION FOR

EMPLOYMENT ELECTRONICALLY, BUT MAY SUBMIT YOUR APPLICATION IN PERSON OR

IN WRITING TO GILA COUNTY HUMAN RESOURCE'S DEPARTMENT.

Electronic Communications

By clicking "Yes, I Accept", you agree to submit an application with Gila County electronically.

You acknowledge that this Agreement is a valid and binding agreement. You agree that your act

of clicking the "Yes, I Accept" button is a binding form of your electronic signature, which you

agree binds you to the terms of this Agreement. You agree that by clicking the "Yes, I accept"

button you are certifying under penalty of law that the information provided anywhere in your Gila

County Employment Application is true, correct and complete to the best of your knowledge and

belief and that this Electronic Signature has the same legal effect and can be treated the same

as your actual handwritten signature.

If you do not wish to submit an Employment Application with Gila County electronically, you may

click, "No, I Refuse" and contact Human Resources as set forth below to obtain information or

submit your application for employment in person or in writing.

To access this Agreement electronically and print a copy of this Agreement for your records, you

must have Internet access, as well as access to a printer. By clicking "Yes, I Accept", you

confirm that you have access to a computer that is capable of accessing the Internet, enabling

you to access Gila County's website. You also confirm that you have access to a printer or the

ability to make a hard copy of this Agreement, and that you have made a copy of this Agreement

for your records. Make sure to print a copy of this Agreement for your records. To print, hit the

"Print" icon located on the front of this Application.

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GILA COUNTY Dear Ap Please read the following (Gila County)

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Completed 14 February 2021

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