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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? 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","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":"
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","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":"
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","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":"
","className":"d-block"},{"type":"paragraph","subtype":"p","label":"GREENE COUNTY DETENTION CENTER
WAIVE AND RELEASE OF ALL CLAIMS AND OF RIGHT TO INSPECT EMPLOYMENT BACKGROUND INVESTIGATION
TO WHOM IT MAY CONCERN:
I, as signed below, am an applicant for a position with the Greene County Detention Center. The Greene County Detention Center needs to thoroughly investigate my employment background and 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 Detention Center. 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 liability for 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 Detention Center’s acceptance and processing of my application for employment, I agree to hold the Greene County Detention Center, 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 Detention Center. 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 and to disclosure of records, and I waive those rights with the understanding that information furnished will be used by the Greene County Detention Center in conjunction with employment procedures. Understanding that complete candor on the part of those from whom information is sought is ensured only by maintaining the confidentiality of a complete background investigation, I do hereby waive, release and forever relinquish any right I might otherwise have pursuant to the Arkansas Freedom of Information Act, the Federal Freedom of information Act, or any other present or future laws granting me a right to inspect the information and records collected as a part of this background investigation. If any portion of this release and/waiver is held to be invalid, the balance shall, notwithstanding, continue in full legal force and effect. My spouse (if any), heirs, and legal representative, and any and all successors and assigns, are bound by the terms of this waiver and Release of All Claims. Further, in consideration of my application for employment, I hereby waive any and all statutory written notice for the release of disciplinary reports, letters of reprimand, or other disciplinary actions. A photocopy or FAX copy of this release form will be valid as an original thereof, even though the said photocopy or FAX copy does not contain an original writing of my signature. I agree to indemnify and hold harmless the person to whom this request is presented and his 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"}]