MCJAS Application Form

Download Complete MCJAS Application Form

Section I - Personal Information
Name*
First Middle Last
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position Applied For
Volunteer / Internship Applied for
Are You Interested in Full Time Work?*
Are You Interested in Part Time Work?*
Are You Interested in Temporary Time Work?*
Are You Interested in Intermittent Time Work?*
Are you a current user of illicit drugs?*
Applicant will be required to have a pre-employment drug testing.
"The passing of acriminal background check is acondition of employment. A conviction record does not automatically exclude you from consideration."
Are you 21 years of age or older?*
Are you eligible to work in the United States?*
If hired, you will be required to provide proper identification and verification of employment eligibility.
Do you have secondary employment that will continue if hired by Multi-County?*
If Yes, will this secondary employment interfere with your schedule, or present any other conflicts with your employment with Multi-County juvenile Attention System?*
Multi-County has facilities in the following counties. Which location would be your preference?
The Multi-County Juvenile Attention System is an equal employment opportunity employer and complies with all employment laws and regulations that prohibit discrimination. We do not discriminate in employment because of race, color, sex, national origin, age or disability.
Section II - Experience
In the areas below, please fill legibly past work experience beginning with the most recent employment. if the title and duties changed materially in the course of your services in any one organisation, indicate such changes clearly and as separate employments. Volunteer work may also be included as employment. Note: a resume not to be used as substitute for completing this page.

Present or Most recent Job:

Employer Name
Telephone Number
Complete Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Length of Employment From
MM slash DD slash YYYY
Length of Employment To
MM slash DD slash YYYY
Reason for leaving
Position
Job Title and Classification
Salary Beginning
Salary Ending
Duties performed

Next Most Recent Job

Employers Name	Telephone Number	Street Address	Address Line 2	State / Province / Region	City	ZIP / Postal Code	Country	Length of Employment From	Length of Employment To	Reason for leaving	Position	Salary Beginning	Salary Ending	Duties performed

Section III - Education and Training

Education

Do you possess a high school diploma or equivalency certificate?*
Total number of years of education
(including primary school)
Highest academic degree or level attained
Name and address of school, college or university where obtained
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
If no degree, last school attended
Major subject area for graduate degree, if any
Major subject area for graduate study without a degree, if any
Major subject area for undergraduate degree, if any
Major subject area for undergraduate study without a degree, if any
Minor subject area(s) for undergraduate degree, if any
If applying for a student help or college intern position, please list the school you are attending
A contact person with phone number

Please list below the specific course work areas relevant to the positions(s) for which you are applying. Also, indicate the number of courses you have successfully completed in each area note: A transcript may be submitted for this section.
Example only: A list of Course work areas for purchasing agent might include:
Course Work AreaNo Of courses
Procurement6
Inventory3
Book Keeping3
Public relations1
Government1
Budgeting1
Course Work Area No. Of Courses

Training and other Qualifications

Computer Skills*
What applications?
If you have received Training or Experience in any other area that you feel is relevant to the position(s) for which you are applying, please submit the following information (do not include training gained as part of your education as described above)
Type of Training Organization Length of Training Subjects Covered
In the area below, please describe briefly any additional information or special qualifications you have for the position(s) requested. Include special machines or equipments you operated, hobbies which have taught you qualifying skills, alos how much time and experience with youth, etc.

Section IV - Miscellaneous
The following information will be used only if it is directly related to the classification/position for which you are applying.
Are you willing and able to secure Driver's Licence, if a license is required?
If No then, please explain
if necessary, can you supply your own transportation for work use?
Have you ever been employed in the state or county services?
If Yes then, please explain
Can you perform the essential job-related requirements of the specific job for which are applying?
If No then, please explain

References

Please list the names and address of three individuals, other than relatives, whom we may contact for a Professional recommendation
Name
First Last
Phone
References Address #1
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
First Last
Phone
References Address #2
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
First Last
Phone
References Address #3
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Previous Addresses

Please list Two most recent addresses with the date of residence
Address #1
Street Address City State / Province / Region ZIP / Postal Code
Dates of Residence
Address #2
Street Address City State / Province / Region ZIP / Postal Code
Dates of Residence

Application will not be accepted if this oath is omitted
In signing below, I am verifying that all of the information I've provided is complete, truthful, and accurate to the best of my knowledge. I further understand that any misrepresentation or omission of pertinent facts is cause for disqualifying me from further consideration. If I am hired and the Multi-County Juvenile Attention System discovers that information provided on this application is inaccurate or incomplete, I understand and agree that this is sufficient cause for separation from employment I understand and agree that this application is not intended to be a contract of employment, and that employment with the Multi-County Juvenile Attention System does not constitute a contractual employment relationship. I understand that I will be required to submit to and pass a criminal background check and drug test, in addition to reference verifications. I hereby give Multi- County Juvenile Attention System permission to verify any and all information that l have provided on this application and release all parties involved from any and all liability for any damage that may result by providing such information.
Signature of Applicant*
Date
MM slash DD slash YYYY

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Course Work Area	No. Of Courses

Type of Training	Organization	Length of Training	Subjects Covered

Section I - Personal Information

Section II - Experience

Section III - Education and Training

Section IV - Miscellaneous