Fremont County Human Resource Department 615 Macon Ave, Suite 106 Canon City, Colorado 81212 Phone: (719) 276-7411 Fax: (719) 276-7412 www.fremontcountyco.gov Application for Employment Fremont County is an Equal Opportunity Employer; we consider all qualified applicants without regard to race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, age, disability or genetic information. IMPORTANT INFORMATION AND INSTRUCTIONS: • Must be at least 18 years of age for all positions, excluding the Fremont County Sheriff’s Office Patrol Division for which you must be at least 21 years of age. • Applications will only be accepted for current job postings. You must complete a separate application for each job posting you are applying for. • You must answer each question fully and accurately. The questions contained within this application are not intended to imply illegal preferences or discrimination based on non-job-related factors. • Incomplete or illegible applications may not be considered. • You may not be contacted unless you are chosen to participate in the interview process. • If applying for the Sheriff’s Office or the Department of Transportation you must complete an addendum application to provide additional information. Position Applied For: ________________________ Today’s Date:_________________ APPLICANT INFORMATION Full Name: ____________________________________________________________________ Address: ____________________________ City: ________________ State: _____ Zip: _____ Telephone Number: ______________________ Email Address:__________________________ **Correspondence will be accomplished by telephone, email or written correspondence. Without accurate and complete contact information your application may not be considered. Are you currently employed by Fremont County Government? ………………………………Yes ☐ No☐ Are you eligible to work in the United States? ……………………………………………… Yes ☐ No☐ Have you applied with us before? If yes, give date(s) previously applied.________________ Yes ☐ No☐ Have you ever worked for us before? If yes, give dates previously employed. ____________ Yes ☐ No☐ On what date would you be available for work………………………………. _____________________________ Are you available to work: Full Time ☐ Part Time ☐ Shift Work ☐ Temporary ☐ Are you related to, married to, or planning on marrying anyone who works for Fremont County? Yes☐ No☐ If so, whom are you related to, married to, or planning on marrying? ______________________________________ How did you hear about us?_______________________________________________________________________ Education You must provide copies of your college transcripts. *Information may be redacted that identifies age, date of birth, or dates of attendance at or graduation from an educational institution. High School____________________________ Address_________________________ Degree/Diploma_________ College______________ Address________________________ Major_________________Degree/Diploma______ University____________ Address________________________Major_________________ Degree/Diploma______ Other (Specify)________ Address_______________________ Major_________________ Degree/Diploma_______  Employment History Provide complete information for previous/present employer in consecutive order (current or most recent employer listed first). Account for all periods of employment, including unemployment and self-employment, for the last seven (7) years. If unemployed or self-employed, list someone who can verify this status in the supervisor box. Note: A job offer may be contingent on acceptable references from current and previous employers. You must complete the employment history section; and you are welcome to attach a resume in addition to this information. Company: _______________________________________ Telephone Number: __________________________ Address: ________________________________________ City: ____________ State: ______ Zip:___________ Supervisor: ______________________________________ Salary: ________________ Dates Employed: From:_____________________ To: ___________________ Hours worked per week: __________________________ Job duties performed: ___________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Reason for Leaving: _______________________________ May we contact them? Yes:☐ No: ☐ Company: _______________________________________ Telephone Number: __________________________ Address: ________________________________________ City: ____________ State: ______ Zip:___________ Supervisor: ______________________________________ Salary: ________________ Dates Employed: From:_____________________ To: ___________________ Hours worked per week: __________________________ Job duties performed: ___________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Reason for Leaving: _______________________________ May we contact them? Yes:☐ No: ☐ Company: _______________________________________ Telephone Number: __________________________ Address: ________________________________________ City: ____________ State: ______ Zip:___________ Supervisor: ______________________________________ Salary: ________________ Dates Employed: From:_____________________ To: ___________________ Hours worked per week: __________________________ Job duties performed: ___________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Reason for Leaving: _______________________________ May we contact them? Yes:☐ No: ☐ Company: _______________________________________ Telephone Number: __________________________ Address: ________________________________________ City: ____________ State: ______ Zip:___________ Supervisor: ______________________________________ Salary: ________________ Dates Employed: From:_____________________ To: ___________________ Hours worked per week: __________________________ Job duties performed: ___________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Reason for Leaving: _______________________________ May we contact them? Yes:☐ No: ☐ Company: _______________________________________ Telephone Number: __________________________ Address: ________________________________________ City: ____________ State: ______ Zip:___________ Supervisor: ______________________________________ Salary: ________________ Dates Employed: From:_____________________ To: ___________________ Hours worked per week: __________________________ Job duties performed: ___________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Reason for Leaving: _______________________________ May we contact them? Yes:☐ No: ☐ For Fremont County positions requiring a current and valid Colorado Driver’s License: Driver's License Number: _______________ State: _______ Expiration Date: _________ List any specialized skills specific to the position you are applying for: (Examples would be equipment, tools, or skills you possess in operating, specialized training you have received applicable to the position, or other relative information.) _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Disclaimer, Release, and Signature I certify my answers are true and correct to the best of my knowledge. I have not made any intentional misrepresentations or omissions. I understand I may be required to submit to a post-offer, pre-employment drug screening (including detection of marijuana) and physical evaluation. I understand employment with Fremont County is “at will” and there are no guaranteed assurances of future or continued employment. I understand should it be discovered I have provided any misleading information on this application it can result in rejection of my application or termination from employment. I authorize representatives from Fremont County to contact and obtain information from employers, schools, licensing authorities, other references, or through a background investigation process. I have read, understand and my signature shows my consent to these statements. Signature: _________________________________ Date: _________________________