VERMONT JUDICIAL BRANCH EMPLOYMENT APPLICATION
Please read the instructions below before completing this
application
Part
A
Position
applying
for:
Job Number:
Job Location:
Name: First, Middle, Last, Suffix (ex: Jr, Sr)
Mailing Address: City, State, Zip Code
Home Telephone
Work (or message) Telephone
Email
Statements
Yes No
Are you 18 years of age or older?
Does your spouse, domestic partner, civil union partner, any relative of any of the
foregoing, or any relative of yours work for the Vermont Judiciary?
Name
Are you authorized to work in the United States?
Instructions
1. The information on this application and any attachments are used to determine the applicant’s
eligibility to compete for any current or future vacancies. All sections of this application must be
completed. Resumes may be attached only for additional information. Copies are acceptable.
2. Print or type all entries. Incomplete or illegible applications will be rejected.
3. Because eligibility to compete for positions is based solely on a review of your application and any
attachments, be sure to complete all items as fully as possible. Use additional sheets to respond to
any items, if necessary. Be certain to include any self-employment, service in the armed forces,
and substantial volunteer work with dates. Periods of six months or more must be accounted for. A
detailed resume, in addition to the data listed here, is encouraged for all administrative, technical,
and professional positions, as well as any other position for which applicants are ranked based on a
rating of training and experience.
Revised 5/18
Education
Do you have a high school diploma or equivalent?
Yes
No
List any college, vocation or other schools attended.
Name and location of
school attended
Fields of study
(Major, minor)
Degree Earned
Ex: BA, MA etc
If not graduated #
of credits
Licenses and
Certificates
Description
Date Issued
Number
Issued By
Training
List any relevant training courses you have taken
Course Title
School Name
Completion Date
Work History (Do Not Refer to
Resume)
Describe your work history below beginning with your current or most recent job.
Job Title
Name of Employer:
Supervisor’s Name
Supervisor’s Title
Phone Number
Address:
City, State, Zip Code:
From (mo./yr.)
To (mo./yr)
Full Time
Part time Hours worked:
Describe the duties you performed.
Did you supervise anyone? Yes
No
Number of years in supervisory position
Reason for leaving:
Job Title
Name of Employer:
Supervisor’s Name
Supervisor’s Title
Phone Number
Address
:
City, State, Zip Code:
From (mo./yr.)
To (mo./yr)
Full Time
Part Time Hours Worked:
Describe the duties you performed.
Did you supervise anyone? Yes
No
Number of years in supervisory position
Reason for leaving:
Job Title
Name of Employer:
Supervisor’s Name
Supervisor’s Title
Phone Number
Address:
City, State, Zip Code:
From (mo./yr.)
To (mo./yr)
Full Time
Part Time Hours Worked:
Describe the duties you performed
Did you supervise anyone? Yes
No
Number of years in supervisory position
Reason for leaving:
Job Title
Name of Employer:
Supervisor’s Name
Supervisor’s Title
Phone Number
Address:
City, State, Zip Code:
From (mo./yr.)
To (mo./yr)
Full Time
Part Time Hours Worked:
Describe the duties you performed
Did you supervise anyone? Yes
No
Number of years in supervisory position
Reason for leaving:
Job Title
Name of Employer:
Supervisor’s Name
Supervisor’s Title
Phone Number
Address:
City, State, Zip Code:
From (mo./yr.)
To (mo./yr)
Full Time
Part Time Hours Worked:
Describe the duties you performed
Did you supervise anyone? Yes No □ Number of years in supervisory position
Reason for leaving:
General
Information
1. The Judicial Branch, State of Vermont is an Equal Opportunity Employer. Discrimination because of
age, sex, race, color, creed, national origin, disabling condition, gender identity, sexual orientation,
and religion. Any applicant for Judicial Branch employment who feels discriminated against in his
or her opportunity for employment may appeal, in writing, to the Court Administrator, no later than
five (5) calendar days from the effective date of the action being appealed.
2. Before being hired you must provide proof of U.S. citizenship or documentation that you are
authorized to work in the United States as required by the Immigration and Control Act of 1986.
3. I understand that the Judiciary may inquire about my criminal record history either during an
interview or once it determines that I am otherwise qualified for the positions. I understand
that if my criminal record history shows any convictions, I will have the opportunity to explain
the information and the circumstances regarding any convictions, including postconviction
rehabilitation. 21 VSA 495j (c )
I hereby certify that my application form and all attachments to it contain no false information and are
complete to the best of my knowledge. I authorize the Court Administrator’s Office Human Resources
Department to make any investigation of my personal history academic/professional credentials, military
service, criminal, and driving records through any investigative bureau of their choice. I am aware that if
an investigation discloses misrepresentation or falsification, my application may be rejected, my name
may be removed from the register and if already employed, I may be dismissed from State service, and I
may be disqualified from applying in the future for any position covered by the Rules and Regulations of the
State of Vermont. Applicant signature is required to be eligible for consideration.
_
Signature or typed name Date
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