EMERGENCY 911

Non-Emergency 870-239-6343

EMERGENCY 911 Non-Emergency 870-239-6343

Application-Clerical

[{"type":"text","required":true,"label":"First Name","name":"first-name","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Middle Name","name":"middle-name","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"Last Name","name":"last-name","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"DL","name":"Drivers-Licence-number","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Street Address","name":"street-address","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"City","name":"city","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"State","name":"State","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR","selected":true},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","required":true,"label":"Zip Code","name":"zip-code","maxlength":10,"className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Length of Residence","name":"length-of-residence","className":"d-block","subtype":"text"},{"type":"text","subtype":"email","required":true,"label":"Email Address","name":"email-address","className":"col-md-6"},{"type":"text","subtype":"email","required":true,"label":"Confirm Email","name":"confirm-email-address","className":"col-md-6"},{"type":"text","subtype":"tel","required":true,"label":"Phone","name":"phone","className":"col-md-6"},{"type":"date","label":"Date Available for Work","name":"date-available","className":"col-md-6"},{"type":"select","label":"Are you at least 18 years of age?","name":"are-you-over-18","className":"d-block","values":[{"label":"-- Select One --","value":"no option selected"},{"label":"Yes - I am at least 18 years of age","value":"yes"},{"label":"No - I am under 18 years old","value":"no"}]},{"type":"select","label":"Are you eligible to work in the US?","name":"eligible-to-work-in-US","className":"col-md-6","values":[{"label":"-- Select One --","value":"no option selected","selected":true},{"label":"Yes - I am eligible to work in the US","value":"yes"},{"label":"No - I am not eligible to work in the US","value":"no"}]},{"type":"select","label":"Are you presently employed?","name":"are-you-presently-employed","className":"col-md-6","values":[{"label":"-- Select One --","value":"no option selected","selected":true},{"label":"Yes - I am presently employed","value":"yes"},{"label":"No - I am presently unemployed","value":"no"}]},{"type":"select","label":"Do you have a valid driver's license?","name":"do-you-have-drivers-license","className":"col-md-6","values":[{"label":"-- Select One --","value":"no option selected","selected":true},{"label":"Yes - I have a valid driver's license","value":"yes"},{"label":"No - I do not have a valid driver's license","value":"no"}]},{"type":"checkbox-group","label":"Are you available to work:","inline":true,"name":"work-availability","className":"d-block","values":[{"label":"Full Time","value":"full time"},{"label":"Part Time","value":"part time"},{"label":"Shift Work","value":"shift work"},{"label":"Temporary","value":"temporary"}]},{"type":"textarea","label":"Skills and Qualifications:","name":"skills-qualifications","subtype":"textarea","rows":5,"className":"d-block"},{"type":"textarea","label":"List any certifications/licenses that are applicable to the position you are applying for.","name":"certifications-licenses","subtype":"textarea","className":"d-block"},{"type":"select","label":"Have you ever been convicted of a felony? (Record of conviction does not necessarily disqualify an applicant from employment considerations.)","name":"felony-conviction","className":"d-block","values":[{"label":"-- Select One --","value":"no option selected","selected":true},{"label":"No - I haven't been convicted of a felony","value":"no"},{"label":"Yes - I've been convicted of a felony","value":"yes"}]},{"type":"header","subtype":"h2","label":"Education","className":"d-block"},{"type":"header","subtype":"h4","label":"School History #1","className":"d-block"},{"type":"text","label":"School Name #1","name":"name-school-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"School Address #1","name":"address-school-1","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"tel","label":"School Phone #1","name":"phone-school-1","className":"col-lg-4"},{"type":"text","label":"Area of Study (School #1)","name":"area-of-study-school-1","className":"d-block","subtype":"text"},{"type":"text","label":"# of Years Completed (School #1)","name":"years-completed-school-1","className":"col-md-6","subtype":"text"},{"type":"select","label":"Did you graduate from School #1?","name":"did-you-graduate-school-1","className":"col-md-6","values":[{"label":"-- Select One --","value":"no option selected","selected":true},{"label":"Yes - I graduated from School #1","value":"yes"},{"label":"No - I did not graduate from School #1","value":"no"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h4","label":"School History #2","className":"d-block"},{"type":"text","label":"School Name #2","name":"name-school-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"School Address #2","name":"address-school-2","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"tel","label":"School Phone #2","name":"phone-school-2","className":"col-lg-4"},{"type":"text","label":"Area of Study (School #2)","name":"area-of-study-school-2","className":"d-block","subtype":"text"},{"type":"text","label":"# of Years Completed (School #2)","name":"years-completed-school-2","className":"col-md-6","subtype":"text"},{"type":"select","label":"Did you graduate from School #2?","name":"did-you-graduate-school-2","className":"col-md-6","values":[{"label":"-- Select One --","value":"no option selected","selected":true},{"label":"Yes - I graduated from School #2","value":"yes"},{"label":"No - I did not graduate from School #2","value":"no"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h4","label":"School History #3","className":"d-block"},{"type":"text","label":"School Name #3","name":"name-school-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"School Address #3","name":"address-school-3","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"tel","label":"School Phone #3","name":"phone-school-3","className":"col-lg-4"},{"type":"text","label":"Area of Study (School #3)","name":"area-of-study-school-3","className":"d-block","subtype":"text"},{"type":"text","label":"# of Years Completed (School #3)","name":"years-completed-school-3","className":"col-md-6","subtype":"text"},{"type":"select","label":"Did you graduate from School #3?","name":"did-you-graduate-school-3","className":"col-md-6","values":[{"label":"-- Select One --","value":"no option selected"},{"label":"Yes - I graduated from School #3","value":"yes"},{"label":"No - I did not graduate from School #3","value":"no"}]},{"type":"header","subtype":"h2","label":"Employment History","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Begin with latest position first. At least 7 years of work history must be provided.","className":"d-block"},{"type":"header","subtype":"h4","label":"Employment History Position #1 (Most Recent or Present Employer)","className":"d-block"},{"type":"select","label":"May we contact your present employer?","name":"may-we-contact-employer-1","className":"d-block","values":[{"label":"-- Select One --","value":"no option selected","selected":true},{"label":"Yes - you may contact","value":"yes"},{"label":"No - you may not contact","value":"no"}]},{"type":"text","label":"Position #1 - Company Name","name":"company-name-job-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"Position #1 - Company Address","name":"company-address-job-1","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","label":"Position #1 - Company Phone","name":"company-phone-job-1","className":"col-md-6"},{"type":"text","label":"Position #1 - Supervisor","name":"supervisor-job-1","className":"col-md-6","subtype":"text"},{"type":"date","label":"Position #1 - Start Date","name":"start-date-job-1","className":"col-md-6"},{"type":"date","label":"Position #1 - End Date","name":"end-date-job-1","className":"col-md-6"},{"type":"text","label":"Position #1 - Job Position Held","name":"position-held-job-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"Position #1 - Rate of Pay","name":"pay-rate-job-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"Position #1 - Reason for Leaving","name":"reason-for-leaving-job-1","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h4","label":"Employment History Position #2","className":"d-block"},{"type":"text","label":"Position #2 - Company Name","name":"company-name-job-2","className":"col-md-6","subtype":"text"},{"type":"text","label":"Position #2 - Company Address","name":"address-job-2","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","label":"Position #2 - Company Phone","name":"phone-job-2","className":"col-md-6"},{"type":"text","label":"Position #2 - Supervisor","name":"supervisor-job-2","className":"col-md-6","subtype":"text"},{"type":"date","label":"Position #2 - Start Date","name":"start-date-job-2","className":"col-md-6"},{"type":"date","label":"Position #2 - End Date","name":"end-date-job-2","className":"col-md-6"},{"type":"text","label":"Position #2 - Job Position Held","name":"position-held-job-2","className":"col-md-6","subtype":"text"},{"type":"text","label":"Position #2 - Rate of Pay","name":"rate-of-pay-job-2","className":"col-md-6","subtype":"text"},{"type":"text","label":"Position #2 - Reason for Leaving","name":"reason-for-leaving-job-2","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h4","label":"Employment History Position #3","className":"d-block"},{"type":"text","label":"Position #3 - Company Name","name":"company-name-job-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"Position #3 - Company Address","name":"address-job-3","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","label":"Position #3 - Company Phone","name":"phone-job-3","className":"col-md-6"},{"type":"text","label":"Position #3 - Supervisor","name":"supervisor-job-3","className":"col-md-6","subtype":"text"},{"type":"date","label":"Position #3 - Start Date","name":"start-date-job-3","className":"col-md-6"},{"type":"date","label":"Position #3 - End Date","name":"end-date-job-3","className":"col-md-6"},{"type":"text","label":"Position #3 - Job Position Held","name":"position-held-job-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"Position #3 - Rate of Pay","name":"rate-of-pay-job-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"Position #3 - Reason for Leaving","name":"reason-for-leaving-job-3","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"References","className":"d-block"},{"type":"paragraph","subtype":"p","label":"List name, address and phone number of three references, which are not related to you and are not previous employers.","className":"d-block"},{"type":"text","label":"Reference #1 - Name","name":"name-reference-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Reference #1 - Phone","name":"phone-reference-1","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"Reference #2 - Name","name":"name-reference-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Reference #2 - Phone","name":"phone-reference-2","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"Reference #3 - Name","name":"name-reference-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Reference #3 - Phone","name":"phone-reference-3","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h4","label":"Upload File","className":"d-block"},{"type":"file","label":"Optional - Attach a PDF to your application submission - resume/additional work or education history/etc. (maximum file size 2MB)","name":"uploaded-files","subtype":"file","multiple":true,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"I understand and agree, that any material misrepresentation or deliberate omission of a fact in my application may result in refusal of, or if employed, immediate termination from employment. It is my understanding that Greene County will make a thorough investigation of my entire work history and may verify all data given in my application for employment, related papers or oral interviews. I authorize such investigation and the giving and receiving of any information requested by Greene County, and I release from liability any person giving or receiving such information. I agree that my employment is at will and may be terminated by Greene County or myself at any time, with or without, notice or cause and without liability for wages or salary, except such as may have been earned at the date of termination. I further understand, that this is an application for employment and that no employment contract is being offered, nor will any result from my employment with Greene County. I understand that if I am employed, such employment is for no definite period of time and that Greene County can change wages, benefits and conditions at any time within the guidelines of employment law. I acknowledge that any oral representation or written statements, which may have been made to me, to the contrary of this paragraph, are expressly disavowed and may not be relied upon.I understand that the Greene County Sheriff's Department needs to thoroughly investigate my employment background personal history to evaluate my qualifications to hold the position for which I applied.  It is in the public's interest that all relevant information concerning my personal and employment history be disclosed to the Greene County Sheriff's Department.I hereby authorize the county or its authorized representative to check any of my information including, but not limited to, criminal history, credit standing, and motor vehicle driving records.  I authorize all persons, schools, companies, and law enforcement authorities to release to the county or its authorized representative any and all employment records and other information about my employment or background.  I hereby release any said persons, schools, companies and law enforcement authorities from any damage whatsoever for issuing this information.  I understand that the information will be used for the purpose of evaluating my application for employment with the county.  For and in consideration of the Greene County Sheriff's Department acceptance and processing of my application for employment.  I agree to hold the Greene County Sheriff's Department, its authorized representatives harmless from any and all claims and liability associated with my application for employment or in any way connected with the decision whether or not to employee me with the Greene County Sheriff's Department.  I understand that should information of a serious criminal nature surface as a result of this investigation such information may be turned over to the proper authorities.  I understand my rights under Title 5, United States Code, Section 552A, the Privacy Act of 1974, with regard to access disclosure of records, and I wave those rights with the understanding that information furnished will be used by the Greene County Sheriff's Department in conjunction with employment procedures.  A photocopy or Fax copy of this release form will be valid as an original therefor, even though the said photocopy or fax does not contain an original writing of my signature.  This waiver is valid for a period of 120 days from the date of my signature.  I agree to identify and hold harmless the person to whom this request is presented and their agents and employees, from and against all claims, damages, losses and expenses, including reasonable attorney's fees arising out of or by reason of complying with this request.  ","className":"d-block"},{"type":"text","required":true,"label":"Applicant Signature","name":"applicant-signature","className":"col-md-6","subtype":"text"},{"type":"date","required":true,"label":"Date Signed","name":"date-signed","className":"col-md-6"}]