APPLICATION FOR EMPLOYMENT

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1 APPLICATION FOR EMPLOYMENT PRINCE WILLIAM-MANASSAS REGIONAL ADULT DETENTION CENTER 9319 Mosby Street, Manassas, Va PHONE: 703/ OR 703/ Adult Detention Center Employment Process Information The Prince William-Manassas Regional Adult Detention Center appreciates your interest in our organization. The agency strives to recruit individuals seeking a career in Corrections. Applications for positions are accepted on an as-needed basis. If you have questions concerning employment opportunities, please contact Sergeant Mary Talley at 703/ or Susan Pepperling at 703/ Please call to have an application mailed to you. Completed applications should only be mailed or hand-delivered to the Human Resources Office. The Human Resources office is located at 9319 Mosby Street, Manassas, VA Office hours are 8:00 a.m. until 4:00 p.m., Monday thru Friday, excluding recognized County holidays. Minimum Qualifications Candidates must meet the following minimum qualifications: Must be a U.S. citizen Must be 21 years of age at time of appointment Must be a high school graduate or its equivalent Must have valid driver s license at time of appointment. Applicants with more than five (5) demerit points are ineligible. Must not have been convicted of any felony or serious misdemeanor Application Process The Adult Detention Center recruitment and selection process supports the Prince William County Equal Opportunity and Affirmative Action Plans. The selection process takes approximately four to eight months after the application has been received. Applicants must successfully complete the following phases: Submit completed application to: Prince William-Manassas Regional Adult Detention Center, Human Resource Office, 9319 Mosby Street, Manassas, VA Criminal history review (date of birth and social security number is necessary to accomplish this) Driving record review Written examination Conditional Offer of Employment Pre-screening interview Polygraph examination Background interview and investigation Medical/Physical examination Final approval by: Superintendent, Human Resources, County Executive Pre-Employment Physical Fitness Test A pre-employment physical fitness test is required only for the Jail Officer position. The Physical Fitness Test Elements may be downloaded by visiting our website at The following will disqualify an applicant for employment: Incomplete application Marijuana use within the past twelve months Use of any other illegal substances Any felony or serious misdemeanor convictions Any alcohol or drug-related driving convictions Conviction of domestic assault Visible tattoos are not permitted Accumulation of more than five demerit points on your current valid driver s license. Out-of-state driving record convictions will be assessed against the Virginia Division of Motor Vehicle point system. PLEASE READ ALL INSTRUCTIONS CAREFULLY & ANSWER ALL QUESTIONS COMPLETELY & HONESTLY

2 APPLICATION FOR EMPLOYMENT PRINCE WILLIAM-MANASSAS REGIONAL ADULT DETENTION CENTER 9319 Mosby Street, Manassas, Va PHONE 703/ OR 703/ Please read all instructions carefully and answer all questions completely. INCOMPLETE APPLICATIONS WILL NOT BE GIVEN CONSIDERATION. Type or print your answers in BLACK INK. If additional space is needed for any item on this form, entries should be continued on a separate sheet of paper and number each entry to correspond with the number of the question on the form. Your name should be on each additional sheet. Be as specific as possible for all requested information. Position: Position Number: Salary Requested: $ Name: Last First MI Address: Street Apt. No. City State Zip Code Social Security Number: - - Telephone: Date Home Available: Work Date of Birth Have you ever been employed by Prince William County Government? YES NO If Yes: Date (s) of employment: to Department: List names of relatives presently employed by Prince William County Government: (Name) (Agency) (Relationship) Person to contact in case of emergency: Name/Relationship: Phone: Home Work: _ EXAMINATION RESULTS: Written Test: Passed: Failed: Date: PRINCE WILLIAM COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER

3 EMPLOYMENT HISTORY APPLICANTS MUST COMPLETE ALL REQUESTED INFORMATION Please provide, in reverse chronological order, your work experience beginning with your present employment for at least the last ten years, (or more if you wish). You must account for all periods of unemployment and military service. List all positions held, including military, part-time, summer and volunteer. 1 Current Position Title: Employer: (Name of company or organization) From: To: Month/Year Month/Year Full-time: _ Part-time: Last salary: $ per Reason for leaving: Type of Organization: Immediate Supervisor: _ Name, Title & Phone Number Describe your duties, responsibilities &accomplishments below: Machines and equipment used: 2 Current Position Title: Employer: (Name of company or organization) _ From: To: Month/Year Month/Year _ Full-time: Part-time: Last salary: $ per Reason for leaving: Type of Organization: Immediate Supervisor: _ Name, Title & Phone Number Describe your duties, responsibilities and accomplishments below: Machines and equipment used:

4 3 Current Position Title: Employer: (Name of company or organization) From: To: Month/Year Month/Year Full-time: _ Part-time: Last salary: $ per Reason for leaving: Type of Organization: Immediate Supervisor: _ Name, Title & Phone Number Describe your duties, responsibilities &accomplishments below: Machines and equipment used: 4 Current Position Title: Employer: (Name of company or organization) _ From: To: Month/Year Month/Year _ Full-time: Part-time: Last salary: $ per Reason for leaving: Type of Organization: Immediate Supervisor: _ Name, Title & Phone Number Describe your duties, responsibilities and accomplishments below: Machines and equipment used:

5 A. EDUCATION Did you graduate from High School? YES NO If NO, do you have a GED? YES NO Complete Section B if you have taken courses in business, trade, armed services, law enforcement, correspondence, or night school). B. Other Training: Name and location City & State Total Date Subject Wks/Hr: Completed Completed Yes No Yes No Yes No C. College, University, or Graduate School Total Credit Hours Completed: Degree Name and location City and State Sem Hrs. Qtr. Hrs. Major/Minor Reeceived Type RECRUITMENT SOURCE: How did you learn of the job for which you are applying? Walk-in County Employee Vacancy List Internet Other Newspaper/Journal (name) Community Agency (e.g., JTPA, VEC) (specify) Job Fair (location) 1. Are you a citizen of the United States? Yes No 2. Have you ever been terminated or forced to resign or have you ever resigned in order to avoid being terminated? If yes, explain Yes No 3. Have you ever been convicted of a crime? (Exclude any offenses committed before your Yes No eighteenth birthday which were adjudicated in a Juvenile Court or committed and expunged under a Youth Offender Law and traffic violations for which you only paid a fine). If yes, explain 4. Have you ever filed for bankruptcy? If yes, when. Yes No 5. Do you have a valid driver s license? State of issue: Yes No 6. May inquiry be made of your present employer regarding your qualifications? Yes No 7. Is there any reason why you cannot perform the duties of the position applied for? Yes No 8. Have you ever applied with this Department previously? If yes, when Yes No 9. Are you fluent in any language other than English? If yes, specify: Yes No PLEASE BE SURE TO SIGN YOUR APPLICATION I hereby certify that this application is a complete record and that all entries given are true and accurate to the best of my knowledge. I understand that any attempt to practice deception or fraud in this application is grounds for disqualification or termination. I consent to verification of all information contained on this employment application and I authorize the Prince William-Manassas Regional Adult Detention Center to contact my references and previous employers to determine my qualifications for this position. SIGNED: DATE:

6 PRINCE WILLIAM COUNTY APPLICANT AFFIRMATIVE ACTION DATA SHEET Prince William County is an Equal Opportunity Employer committed to affirmative action. We, therefore, desire to take affirmative steps to hire, train and promote all qualified persons. We are asking you to help us measure the effectiveness of our program by answering the questions below. It would help us if you would complete an Applicant Affirmative Action Data Sheet for each position for which you wish to be considered. The information collected will be used for statistical purposes only. Your assistance is appreciated. Position Applied For: Position #: Date: Name: Last First Middle Initial Birth Date: / / Sex: ( ) Male ( ) Female Month Day Year Ethnic Origin (please check one): NOTE: Ethnic Origin is defined by the Federal Equal Employment Opportunity Commission as follows: ( ) White - (not of Hispanic origin) All persons having origins in any of the original peoples of Europe, North Africa or the Middle East. (Excluding Spain). ( ) Black - (not of Hispanic origin) All persons having origins of any of the Black racial groups of Africa. ( ) Asian or Pacific Islanders - All persons having origins in any of the original peoples of the Far East, Southeast Asia, Subcontinent of India, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands, Samoa, India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan. ( ) American Indian or Alaskan Native - All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. ( ) Hispanic - Persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin. ( ) Other - Not specifically identified in any of the above categories. How did you learn of the job for which you are applying? ( ) Walk-in ( ) From a County employee ( ) Newspaper advertisement (specify) Name of Paper ( ) Vacancy List ( ) Community agency (e.g. JTPA, VEC) (specify) _ name ( ) Church name ( ) Civic Association name ( ) School Referral name ( ) Radio/T.V. Station Letters ( ) Magazine/Prof. Journal name ( ) U.S. Military Base name ( ) Other Source (please list)

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