Free Judicial Employment Application - Vermont

VERMONT JUDICIAL BRANCH EMPLOYMENT APPLICATION
Please read the instructions below before completing this application Office Use Only Applicant # Meets Minimums: Yes No T & E Score Date

Job Title: Name: First, Middle, Last, Suffix (ex: Jr, Sr) Mailing Address: City, State, Zip Code Home Telephone

Job Location: Any Place in VT

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? In the past five years have you been convicted, imprisoned, placed on probation or under supervision, or fined for any violation of any law including motor vehicle violations? In the past fifteen years have you been convicted of a Felony? If ''YES'' to either question, give dates, details and penalties for each occurrence on a separate sheet of paper (8.5'' x 11''), which must accompany your application. 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. You must submit a separate application including the job title for each position applied for. Copies are acceptable. 2. Print or type all entries. Incomplete or illegible applications will be returned. 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 selfemployment, service in the armed forces, 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.
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Education Yes Do you have a high school diploma or equivalent? Name and location of school attended

No If not graduated # of credits

List any college, vocation or other schools attended. Dates attended Fields of study Degree Earned (Major, minor) Ex: BA, MA, etc.

Licenses and Certificates Description Date Issued Number Issued By

Course Title

Training List any relevant training courses you have taken Completion Date School Name

Work History (Do Not Refer to Resume) Describe your work history below beginning with your current or most recent job. Name of Employer: Job Title Supervisor's Name Address: From (mo./yr.) To (mo./yr.) Supervisor's Title City, State, Zip Code: Full Time Part Time Current Salary Hours Worked: Phone Number

Describe the duties you performed.

Did you supervise anyone? Yes Reason for leaving:
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No

Number of years in supervisory position

Job Title Supervisor's Name Address: From (mo./yr.) To (mo./yr.)

Name of Employer: Supervisor's Title City, State, Zip Code: Full Time Part Time Salary Hours Worked: Phone Number

Describe the duties you performed.

Did you supervise anyone? Yes Reason for leaving:

No

Number of years in supervisory position

Job Title Supervisor's Name Address: From (mo./yr.) To (mo./yr.)

Name of Employer: Supervisor's Title City, State, Zip Code: Full Time Part Time Salary Hours Worked: Phone Number

Describe the duties you performed.

Did you supervise anyone? Yes Reason for leaving:

No

Number of years in supervisory position

Job Title Supervisor's Name Address: From (mo./yr.) To (mo./yr.)

Name of Employer: Supervisor's Title City, State, Zip Code: Full Time Part Time Salary Hours Worked: Phone Number

Describe the duties you performed.

Did you supervise anyone? Yes Reason for leaving:

No

Number of years in supervisory position

Job Title Supervisor's Name Address: From (mo./yr.) To (mo./yr.)

Name of Employer: Supervisor's Title City, State, Zip Code: Full Time Part Time Salary Hours Worked: Phone Number

Describe the duties you performed.

Did you supervise anyone? Yes Reason for leaving:

No

Number of years in supervisory position

Veterans' Preference Complete this section if you wish to claim Veterans' preference points Preference points will be added to the passing scores of eligible veterans of the United States Armed Forces, as provided in 20 V.S.A. 1543 and 3 V.S.A. 310(f). In general, an eligible veteran is any person who served in the United States Armed Forces for at least 90 days and was separated under Honorable or other acceptable condition. Additional preference points may be claimed if you meet any of the following requirements: (1) a veteran with a service connected disability; (2) the spouse of a totally disabled veteran with a service connected disability; or (3) the unmarried widow or widower of a veteran. Please check any of the following which apply and provide a copy of a Letter of Certification from the Veterans Administration. Yes No Have you served on active duty in the United States Armed Forces for at least 90 days and been discharged under Honorable or other acceptable conditions? Have you served on active duty in the United States Armed Forces for at least 90 days and been discharged under Honorable or other acceptable conditions AND have a service-connected disability of 10% or more? Are you a spouse of a totally disabled veteran (100%) with a serviceconnected disability? (Note: the veteran must have served on active duty in the United States Armed Forces for a least 90 days and been discharged under Honorable or other acceptable conditions). Are you an unmarried widow or widower of a veteran? (Note: the veteran must have served on active duty in the United States Armed Forces for at least 90 days and been discharged under Honorable or other acceptable conditions). 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, sexual orientation, religion or any other non-merit factor is prohibited. 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. Applications are kept on file for one year. Individuals who have applications on file need to notify the Court Administrator's Office in writing if they want to be considered for new vacancies but need not file a new application. 3. 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. Return fully completed application and address any further inquiries to: Office of the Court Administrator 109 State Street Montpelier, VT 05609-0701 Phone: (802) 828-3278 TTY (802) 828-3234

Yes

No

Yes

No

Yes

No

Revised 11/06 SML

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 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 of Applicant

Date

Referral Source
Select the Referral Source that best describes the way you FIRST learned about the job opportunity you are applying for. The Internet Newspaper Ad Judiciary Human Resources Office Other Other State of Vermont Office A referral from a current employee Employment and Training Career Resource Center

Revised 11/06 SML

APPLICANT EEO SURVEY The Vermont Judiciary is an Equal Opportunity/Affirmative Action Employer. The information requested below is gathered to comply with Federal record keeping regulations and Equal Employment Opportunity/Affirmative Action requirements. You are not required to furnish this information; however, your cooperation is strongly encouraged and appreciated. The information on this form is CONFIDENTIAL and will be available only to authorized personnel for research and evaluation purposes. This page is separated from your application prior to review and destroyed after data entry. What is your gender? Male Female How do you describe yourself?
Black (not of Hispanic origin): Persons having origins in any of the Black racial groups of Africa. American Indian or Alaskan Native: Persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. Asian or Pacific Islander: Persons having origins in any of the original peoples of the far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Samoa. Hispanic: Persons of Mexican, Puerto Rican, Cuban, Central or South American or any other Spanish culture or origin, regardless of race. White: (not of Hispanic origin): Persons having origins in any of the original peoples of Europe, North Africa or the Middle East.

Revised 11/06 SML