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Please Print in Black or Blue Ink or Type

This document is a job application for employment with the Kansas Judicial Branch. It requests basic contact information as well as employment history, education, and references. It also includes an acknowledgment authorizing a background check and releasing liability. The applicant is asked to provide optional demographic information to assist with evaluating recruitment and hiring practices.

Uploaded by

Seamus Ward
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
46 views

Please Print in Black or Blue Ink or Type

This document is a job application for employment with the Kansas Judicial Branch. It requests basic contact information as well as employment history, education, and references. It also includes an acknowledgment authorizing a background check and releasing liability. The applicant is asked to provide optional demographic information to assist with evaluating recruitment and hiring practices.

Uploaded by

Seamus Ward
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 5

FOR AGENCY USE ONLY:

Date Received:___________
Initials of Recipient: ______

KANSAS JUDICIAL BRANCH


APPLICATION FOR EMPLOYMENT
Read the job announcement thoroughly and apply only if you feel reasonably certain you meet the
requirements. Clearly state your qualifications. Incomplete or illegible applications may be disqualified. Each
section must be answered completely. If a question does not apply to you, write N/A. If you need assistance
with this application or any other part of the application process, please contact the person to whom the
application is to be submitted.
Equal Opportunity Employer
We consider applicants for all positions, regardless of race, sex, religion, color, national origin, age, ancestry or
disability.
Please print in black or blue ink or type:
Position applying for:
Location of position:
Name:
(Last)

Street Address:
City:
Home phone:
Cell phone:
Social Security Number:

Date of application:

(First)

(Middle)

State:
Work phone:

(Other name)

Zip Code:

E-mail:
(Furnishing this number is voluntary. If provided, it will be used to

distinguish persons with similar names)

1.
2.
3.
4.
5.
6.
7.
8.
9.

Have you ever been employed by the Kansas Judicial Branch?


Yes
No
Have you ever been fired from a job or forced or asked to resign?
Yes
No
Have you ever been disciplined at work?
Yes
No
Have you ever been convicted of a felony? (A conviction will not necessarily disqualify the applicant from employment)
Yes
No
If you answered Yes to either question 2, 3, or 4, please explain on a separate piece of paper.
Do you have a valid Kansas drivers license? Yes _____ No _____ License #
If hired, can you provide proof of eligibility to work in the United States? (e.g., drivers license and social security
card) Yes ___ No ___
Available to work: Full time __ Part time __ Temporary __
If hired, what date would you be available for work?
If hired, are you available for travel? Yes _____ No _____

Give the name, address and telephone number of three references who are not related to you, stating the length
of time known and the nature of the relationship:
Ref. #1:
Ref. #2:
Ref. #3:

APP-1

EDUCATION
1. Do you have a __ High School Diploma or GED __BA/BS __MA/MS __PhD/JD __ Other (Vo-tech,
etc.)_____________________?
2. If currently attending school, when do you expect to graduate?
School from which you received the required diploma or most recent school attended:
Address:
Attended from (dates):
Major course work:

to
Degree or Credit hours

If the position for which you applied requires a diploma or degree, you should be prepared to supply an official
copy of the school transcript or diploma upon request.
EXPERIENCE
Describe each position you have held in the past 10 years, including individual positions with the same
employer and military service. If necessary to meet the experience requirement for a position, you may report
experience prior to the past 10 years. Begin with your current or most recent position and work backwards. If
you need more report sheets than are provided, you may attach additional pages to present the requested
information, or attach a detailed resume.
From ___/___ to ___/___ Position Title:____________________________ Hours/Wk
Month/Year

Month/Year

Name and address of Employer


Immediate Supervisor
Ending Salary:
Duties (state % of time for major duties):

Telephone:
Number of people supervised:

Reason for leaving?


From ___/___ to ___/___ Position Title:____________________________ Hours/Wk
Month/Year

Month/Year

Name and address of Employer


Immediate Supervisor
Ending Salary:
Duties (state % of time for major duties):

Telephone:
Number of people supervised:

Reason for leaving?

APP-1

From ___/___ to ___/___ Position Title:____________________________ Hours/Wk


Month/Year

Month/Year

Name and address of Employer


Immediate Supervisor
Ending Salary:
Duties (state % of time for major duties):

Telephone:
Number of people supervised:

Reason for leaving?


From ___/___ to ___/___ Position Title:____________________________ Hours/Wk
Month/Year

Month/Year

Name and address of Employer


Immediate Supervisor
Ending Salary:
Duties (state % of time for major duties):

Telephone:
Number of people supervised:

Reason for leaving?


OTHER RELEVANT EXPERIENCE
1. Can you type? Yes _____ No _____ At what speed? __________
2. Describe your computer experience in detail:

3. After reviewing the duties of this position, please describe any additional activities, training, or experience
that qualify you for the position for which you are applying:

APP-1

ACKNOWLEDGMENT AND AUTHORIZATION FOR RELEASE OF INFORMATION


I understand and agree that:
1. The Judicial Branch may conduct an investigation of my work history and other relevant background
and may verify all data given in or relating to my application for employment. By signing this
authorization, I authorize such investigation and the giving and receiving of any information
requested by the Judicial Branch, including any documents or other information relating to my
employment history, and I release from liability any person giving or receiving such information,
including employers, supervisors and co-workers if contacted. I also acknowledge and agree that
any job offer that is made to me may be conditioned upon the results of a criminal history check, which I
hereby authorize.
2.

By signing this application, I am verifying that the information given by me in this application is true
and correct. I understand that any false or misleading information may prevent my being hired, or, if
hired, may subject me to immediate dismissal.

3. I understand that any offer of employment may be conditional upon my providing further information as
required by the Judicial Branch, including but not limited to transcripts from educational institutions or
degrees, if required, or executing additional consents to release of information, if required.
4. I understand this application is submitted for this position only. Employer has no obligation to keep the
application on file or to consider me for future openings.
5. I represent that I can perform the essential functions of the position for which I am applying, with or
without a reasonable accommodation.

Applicants Signature

Date Signed

Printed Name of Applicant

APP-1

APPLICANT CHARACTERISTIC SURVEY


TO ALL APPLICANTS: The information requested below will in NO WAY affect you as an individual applicant. This
information is necessary because the Kansas Judicial Branch is undertaking a study of its recruitment, selection, and
appointment methods. Information collected from the applicant characteristic survey will be kept separate, part from the
personnel files, in a limited access file and will be used for statistical compilation and analysis.
THIS WILL NOT BE USED FOR EMPLOYMENT DECISIONS
INSTRUCTIONS: Please circle the correct number in each question.
A.

B.

What is your age group?


1. 19 or less

4. 40-49 years

2. 20-29 years

5. 50-59 years

3. 30-39 years

6. 60-69 years

What is your sex?


1. Male
2. Female

C.

What is the highest level of education you have completed?


1. 0-8 years
2. 9-12 years, but no high school diploma
3. High school graduate, or equivalent (e.g., G.E.D.)
4. Post High school or business school training
5. College, less than B.A., or B.S., or similar degree
6. B.A., or B.S., or similar degree
7. M.A., or M.S., or similar degree
8. Ph.D., or J.D. or similar degree

D.

Of the following, which racial/ethnic group do you consider yourself a member?


1. African-American or Black Non-Hispanic
2. American Indian or Alaskan Native Non-Hispanic
3. American Indian or Alaskan Native and White Non-Hispanic
4. American Indian or Alaskan Native and Black Non-Hispanic
5. Asian Non-Hispanic
6. Asian and White Non-Hispanic
7. Black and White Non-Hispanic
8. Hispanic or Latino
9. Native Hawaiian or Other Pacific Islander Non-Hispanic
10. White Non-Hispanic
11. Two or More Races Not Described Above

E.

How did you learn about this job?


1. Newspaper

6. A State Agency

2. Kansas Job Service Center

7. Community Organization

3. Court Employee

8. Internet

4. Friend

9. Notice of Vacancy Report

5. School Placement Center

10. Other

Position you are applying for:


County you applied in:
IMPORTANT TO COURT EMPLOYEES:

Date:
This survey MUST be separated upon acceptance of the application, and
separately filed, from applicant files.
APP-1

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