APPLICATION GUIDELINES

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1 Northern Arizona Council of Governments 119 East Aspen Avenue Flagstaff, Arizona Job Line: (928) * Fax: (928) Main Line: (928) Ext APPLICATION GUIDELINES NACOG would like to thank you for your interest in our organization. To ensure your application is processed accurately, please review the following information BEFORE filling out your application. You may detach these guidelines and instructions for your records. Applications are accepted for advertised positions ONLY. (Exceptions: Applications for monthly pool advertisements, which may be submitted at the Head Start Centers). AN INDIVIDUAL APPLICATION IS REQUIRED FOR EACH POSITION YOU ARE APPLYING FOR. Resumes are optional and CANT be substituted for the application. Applications submitted in person MUST BE received on or before the designated closing date by 5:00 p.m. September to May or 4:00 p.m. June to August. Applications that are mailed and post marked on or before the closing date will be accepted. Applications sent via fax or must be received by the closing date and time designated above. All applications MUST have the original signature of the applicant to be considered valid. Xeroxed, ed and/or faxed copies of the application are acceptable, HOWEVER, for faxed and ed copies, you will be required to bring in or mail the application with your original signature. Copies of certificates and awards may be included with the application as supporting documentation. Please DO T send originals, as they will not be returned. Please attach your college transcripts for professional/exempt level positions to expedite the review process. (i.e. Head Start Teacher and Teacher Aide.) Please fill out all information requested on the application. "SEE RESUME" IS T ACCEPTABLE. (Applications will be returned as incomplete!!) PLEASE TYPE OR PRINT LEGIBLY. Use blue or black ink ONLY! BEFORE you sign your name, please read the "Conditions of Employment" disclosure on last page of the employment application.

2 INVITATION TO SELF IDENTIFY: (OPTIONAL) NACOG APPLICATION INSTRUCTIONS The information you provide is voluntary and in no way shall affect your application for employment. The information is to be used for statistical and federal reporting purposes. For those who wish to disclose the appropriate information please complete your name, date applied, position applying for, location (work site) and department. Circle the response best suited for your response. APPLICATION FOR EMPLOYMENT: (MUST be completed in its entirely) 1. Position Information Indicate the POSITION /CITY you are applying for (refer to advertisement, recruitment notice or job line). An application is required for each position so if you are applying for two positions you must submit two applications. 2. Personal Information Last Name, First Name, (both MUST reflect the name as indicated on your Social Security Card) and Social Security Number. Mailing Address, City, State and Zip Code (required for notification of application status). Home Phone Number (if none listed, may delay notification process). Message Phone Number (optional). Alternate Contact Source (where applicable - please be specific and include most current information). United States Citizen Status (circle your response and provide supporting information where requested). Other Pre-Employment Information (Circle your response and provide additional information where applicable). 3. Educational Information High School (provide the name, city and state) and circle the highest grade completed. Post-Secondary Education (provide name, city and state of college/university/or other schools) including vocational or technical schools. Dates Attended, Credit Hours Completed, Type of Degree Earned (if acquired) and Curriculum (Major and Minor). List any course(s) or workshop(s) relevant to the position for which you are applying. 4. Other Important Information Provide a list of computer software and/or hardware you are knowledgeable with and years of experience. List all pertinent professional organizations, affiliations, and/or honors. List additional information (including skills, experiences, education, background and interests) which may fully describe your qualifications to the position for which you are applying. 5. Employment History (MUST be completed. "See Resume" Is Not acceptable. Applications will be returned as incomplete) List all previous employers in chronological order, beginning with the most CURRENT. Provide the dates of employment from beginning to end by month and year (mm/yy or 01/99). Indicate the employer's name, address (city, state and zip code) and phone number (including area code). Provide the (official) position title, salary (starting and ending) and supervisor's name. List the essential functions (or summary) of the position duties and responsibilities (attach additional sheets if necessary). Indicate the reason for leaving (provide a brief and relevant statement). 6. References List (3) three people other than relatives or supervisors who can attest to your character and ability regarding the position for which you are applying, (please include phone numbers for direct contact).

3 Northern Arizona Council of Governments 119 East Aspen Avenue * Flagstaff, AZ Job Line (928) * Fax (928) Main Line (928) Ext AN EQUAL OPPORTUNITY EMPLOYER INVITATION TO SELF IDENTIFY The purpose of this data record is to comply with governmental record keeping, reporting and other legal requirements. Periodic reports are made for the government based on the information listed below. The completion of this data record is OPTIONAL. All data records are kept in a confidential file and are not a part of your Application for Employment or personnel file. Last Name: First Name: Date: Position: City: *You may complete the following section by circling the appropriate lines below. I choose not to submit any of the personal information listed below. Gender Female Male Ethnicity White Native American Hispanic or Latino Black or African American Asian Native Hawaiian or other Pacific Islander Two or More Races How did you come across this open position? NACOG Job Line NACOG Website Other (specify) NACOG Employee NACOG Recruitment Notice Newspaper Whom? Specify: Veteran Status Vietnam Era Veteran Disabled Vietnam Era Veteran Veteran-Other Disabled Veteran Other Not Applicable

4 APPLICATION FOR EMPLOYMENT Northern Arizona Council of Governments Human Resources 119 East Aspen Ave * Flagstaff, AZ Job Line (928) * Fax (928) Main Line (928) Ext Position: Position Information Location: *A separate application is required for each position. Personal Information Legal Last Name: Legal First Name: Social Security # - - Mailing Address: City, State: Zip Code: Home Phone Number: ( ) Message Phone Number: ( ) If you do not have a phone, how may we contact you? Are you a citizen of the United States? If not, do you hold the legal right to be employed in the US? (Circle one) If you are not a citizen, but have answered "Yes" above, please provide your Visa #: If hired, you will be required to submit proof of identity and eligibility to work in the US as required by the Immigration Reform and Control Act of Have you ever been convicted, plead guilty or no contest to anything other than a minor traffic violation? If yes, attach information including the offense, date and conviction. A conviction will not automatically disqualify you from employment. Each case will be assessed on the relevance of the conviction to a hiring decision. Have you previously been employed by NACOG? If yes, when? Do you have any relatives who are employed by NACOG or serve on a NACOG Board or Council? If yes, provide name and relationship: Are you a Head Start parent? Have you ever been discharged from any employment or asked to resign? If yes, please explain: Are you applying for a job which requires a Driver's License? If yes, please complete: License#: Class: State: If you are hired or transferred into a position that requires the operation of a vehicle, we will require a DMV investigation. Do you authorize investigation of your DMV record? Do you authorize a background investigation including prior employers, education and criminal records? Please complete entire application even if you attach a resume. Incomplete applications will not be considered for employment.

5 Page 1 of 4 Educational Information Name and Location (City/State) of last high school: Circle last grade completed in high school: GED Name and Location (City/State) of College/ University/Other Schools From Dates Attended To Number of Credit Hours Completed Type of Degree Earned Major Curriculum Minor List any courses or workshops you have attended that relate to the job for which you are applying: Other Important Information List computer software and hardware you can use and years of experience: Word Processing: List professional organizations, affiliations and/or honors: WPM Employment History Please list all previous employers starting with your present or most recent position below Page 2 of 4

6 Employment History Continued Please list all previous employers starting with your present or most recent position below Starting Salary Ending Salary Hours Per Week Full Time Part Time If you need more space for Employment History, please photocopy this page. Page 3 of 4

7 Additional Information Please list any additional information which may more fully describe your qualifications, skills, experience, education, background and interests. References List 3 persons other than relatives or supervisors who can attest to your character and ability regarding the position for which you are applying. Name Title Address Phone Number Conditions of Employment Please read carefully before signing. You must sign this statement to be considered for employment. I certify that the information given herein is true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment, as necessary, to arrive at an employment decision. I understand that this application is not intended to be an employment contract. I also understand that if I am employed by NACOG, my employment is "at will," and NACOG or I may terminate the employment relationship at any time, for any reason, with or without notice. I further understand that no employee of NACOG has the authority to modify the understanding orally or in writing except with the permission of the Executive Director. I further understand that employment is probationary for a period of 6 to 12 months and that successful completion of this period does not guarantee regular employment. In the event of employment, I understand that false or misleading information given herein or during an interview may result in discharge. I also understand that if employed, I am required to abide by all NACOG rules and regulations. Applicant's Signature Date Page 4 of 4

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