Form Center

Step One

Important
There is no save button, so please make sure you have all the information you need prior to starting this application.
White Pine County Human Resources
801 Clark St. Suite #2
Ely, Nevada 89301
Phone Number: 775-293-6596
Fax Number: 775-289-1558
White Pine County: An Equal Opportunity Employer
If you believe you require an accommodation during the selection process, please contact us to make appropriate arrangements
Continue

Name*
Date*
Date
Address*
City*
State*
Zip*
Email Address*
Telephone Numbers
You must provide at least one.
Home Phone
Cell Phone
Work Phone
Position Applied for*
How did you hear about this position?*
Who referred you?
If other, please explain
If offered employment, when will you be available to begin?*
If offered employment, when will you be available to begin?
Continue |Go Back

Did you graduate from high school or receive a GED certificate?*
1. Yes
2. No
Please list all Business/ Technical/ Vocational schools you have attended.*
List the following: Location of the school, Hours/ Credits Earned, Diploma / Degree/ or Certificates, and Major Field of Study.
Please list all Colleges/ Universities you have attended (Undergraduate).*
List the following: Location of the school, Hours/ Credits Earned, Diploma / Degree/ or Certificates, and Major Field of Study.
Please list all Graduate Schools you have attended.*
List the following: Location of the school, Hours/ Credits Earned, Diploma / Degree/ or Certificates, and Major Field of Study.
Continue |Go Back

List current licenses, certifications, or registrations required for the position for which you are applying for.
Indicate types, state license, numbers, and expiration dates.
Answer only if position requires.
Do you have a valid driver's license?
1. Yes
2. No
If so, license expires
Insert expiration date
Class
Insert license class
Restrictions (if any)
Insert any restrictions
In addition to English, list any other language abilities you possess.
Verbal fluency in
Written fluency in
List any special skills you possess and/ or equipment or office machines you can operate.
Continue |Go Back

Have you ever been disciplined in your employment related to work place violence?
1. Yes
2. No
If yes, please explain
Do you presently use illegal drugs?
1. Yes
2. No
Have you ever been employed by White Pine County?
1. Yes
2. No
If yes, please provide the following information:
Please list the Department, Position Title, Dates of Employment, and Reason for Separation
Are you related to anyone who is currently employed by White Pine County?
1. Yes
2. No
If yes, please provide the following information:
Please list the Related Person's Name, Department, and Relationship.
Continue |Go Back

1) AS A PEACE OFFICER OR FIREFIGHTER.
2)WHICH HAS ACCESS TO THE NEVADA CRIMINAL JUSTICE INFORMATION
3)WHICH A STATE OF FEDERAL LAW REQUIRES CRIMINAL HISTORY INFORMATION.
Have you been convicted of, pled guilty or nolo contendre to, or been granted deferred adjudication for a felony, misdemeanor (excluding juvenile adjudication), or any lesser crime other than a minor traffic infraction?
1. Yes
2. No
Do you have any pending court charges that have not been adjudicated?
1. Yes
2. No
If you have answered yes to either question, list all such offenses and provide date, name of court, and disposition (if any). You may omit minor traffic violations for which you paid a fine of $50 or less. Omission of information may be considered cause for disqualification from the employment pre-screening process or result in termination of employment.
Continue |Go Back

Provide information regarding all paid employment (include military employment if duties/assignments relate to the job you are applying for). Volunteer work which may be related to the position for which you are applying should also be provided. Describe your most recent position first; then list other positions in order held. Use a separate block for each position, even if with the same employer. Use additional sheets if necessary. Do not use references such as “See Résumé” in place of completing this section.
May we contact all employers listed? (Attach a list of any exceptions with an explanation.)*
1. Yes
2. No
Present Employer
Present Position
Related Duties
Address
City
State
Zip Code
Beginning and Ending Date
Beginning and Ending Date Start Date
—
Beginning and Ending Date End Date
Supervisor's Name and Title
Phone Number
Reason for Leaving
Upload Resume*
Upload References*
Continue |Go Back

Please read all of the following statements and initial each of the lines to indicate you have read and understand each of the statements. If you have any questions, please call Human Resources at 775-293-6596.
All offers of employment and all information regarding compensation and other terms and conditions of employment will be made in writing. Verbal statements may not be relied upon*
This application is the property of White Pine County and will become part of my personnel file if I am hired.*
Additionally, my signature below certifies that the information provided is true and correct to the best of my knowledge.
E-Signature of Applicant*

Leave This Blank: