APPLICATION FOR EMPLOYMENT The Criminal Justice Institute is an Equal Opportunity/Affirmative Action Employer

CRIMINAL JUSTICE INSTITUTE           

University of Arkansas System                             

7723 Colonel Glenn Road                                      

Little Rock, Arkansas  72204                                             

(501) 570-8000

 

 

 

Notice:  Applications filed do not create a contract of employment with the Criminal Justice Institute or the University of Arkansas System.  If you are hired, employment is not for any definite period of time.  All employees of the Criminal Justice Institute whether full-time, part-time, extra help or otherwise, may be terminated at any time or be dismissed for cause under University procedures.    Please answer all questions which apply to you and mark those that do not apply with N/A.
LAST NAME	FIRST NAME		MIDDLE NAME
MAILING ADDRESS		CITY	STATE	ZIP CODE
HOME PHONE NUMBER	WORK PHONE NUMBER		ALTERNATE PHONE NUMBER
POSITION(S) APPLYING FOR:			DATE AVAILABLE FOR EMPLOYMENT:

 

EMPLOYMENT STATUS
Are you seeking full-time employment?           YES          NO	Part-time?            YES         NO
Would you accept temporary employment?     YES          NO	Preferred Schedule:
Have you ever filed an application with this agency?   YES       NO	If yes, what was your name at that time?

 

EDUCATIONAL HISTORY
High School or GED completed?    YES    NO		If “NO,” number of years completed:
NAME AND LOCATION OF COLLEGES  OR SCHOOLS ATTENDED	DATES ATTENDED	MAJOR SUBJECT OR COURSE	DEGREES OR CERTIFICATES RECEIVED
	From
	To
	From
	To

 

EDUCATIONAL HISTORY, Continued
	From
	To
	From
	To
	From
	To

 

SPECIAL SKILLS AND TRAINING
List any skills and special training not indicated in the Educational History section such as equipment operation, software, typing, etc.
1.	5.	9.
2.	6.	10.
3.	7.	11.
4.	8.	12.

 

EMPLOYMENT EXPERIENCE
Starting with your current or most recent employer, please give complete full-time and part-time employment history and any other relevant work experience.  Explain any gaps in employment in the comments section.  Volunteer experience may be listed in the absence of paid employment.
Current or most Recent Employer:	Begin Date (mo./yr.)	End Date (mo./yr.)
Address:	Telephone:
Job Title:                                                            Full-time?         Part-time?	Beginning Salary:	Ending Salary:
Supervisor:	Reason for leaving?
Duties performed:

 

 

EMPLOYMENT EXPERIENCE, Continued
Employer:				Begin Date (mo./yr.)		End Date (mo./yr.)
Address:				Telephone:
Job Title:                                                                Full-time?          Part-time?				Beginning Salary:		Ending Salary:
Supervisor:				Reason for leaving?
Duties performed:
Employer:				Begin Date (mo./yr.)		End Date (mo./yr.)
Address:				Telephone:
Job Title:                                                                Full-time?           Part-time?				Beginning Salary:		Ending Salary:
Supervisor:				Reason for leaving?
Duties performed:
Employer:				Begin Date (mo./yr.)		End Date (mo./yr.)
Address:				Telephone:
Job Title:                                                                Full-time?           Part-time?				Beginning Salary:		Ending Salary:
Supervisor:				Reason for leaving?
Duties performed:
EMPLOYMENT EXPERIENCE, Continued
Employer:				Begin Date (mo./yr.)		End Date (mo./yr.)
Address:				Telephone:
Job Title:                                                                Full-time?           Part-time?				Beginning Salary:		Ending Salary:
Supervisor:				Reason for leaving?
Duties performed:
Employer:				Begin Date (mo./yr.)		End Date (mo./yr.)
Address:				Telephone:
Job Title:                                                                Full-time?           Part-time?				Beginning Salary:		Ending Salary:
Supervisor:				Reason for leaving?
Duties performed:
Comments (including any gaps in employment)?
May we contact all current/previous employers?	Yes	No	Please do not contact:
Provide any other names under which you have been employed.
If you are under 18 years of age, can you provide required proof of eligibility to work?					Yes		No
Can you provide proof of citizenship or authorization to work in the U.S. upon employment?					Yes		No
Have you been convicted of a felony within the last ten years? Conviction will not necessarily prevent you from obtaining employment.					Yes		No
If yes, please explain.

 

Do you have any relatives working for the Criminal Justice Institute?	Yes	No
If yes, what is the relationship?

 

EMPLOYMENT REFERENCES
Please list any individuals that can be contacted to provide a professional reference for you.  You must complete the Employment Consent and Release Form attached to this application before any references can be contacted.
Name:	Telephone Number:
Address:
Comments:
Name:	Telephone Number:
Address:
Comments:
Name:	Telephone Number:
Address:
Comments:
Name:	Telephone Number:
Address:
Comments:

 

MILITARY EXPERIENCE
Have you served in the U.S. Armed Forces or National Guard?	Yes	No
If so, what branch?	Dates of Service:
Describe duties and special training:

I certify that the information given herein is true and complete to the best of my knowledge.  I understand that a representative of the Criminal Justice Institute may verify the information in the event of employment, and I understand that false or misleading information given in my application or interview(s) may result in termination.  I also understand that I am required to abide by all rules and regulations of the employer.

 

SIGNATURE OF APPLICANT:                                                                DATE:                                      

CRIMINAL JUSTICE INSTITUTE

UNIVERSITY OF ARKANSAS SYSTEM

 

EMPLOYMENT REFERENCE CONSENT AND RELEASE

 

I,                                                                                   hereby give consent to any and all prior employers of mine, my current employer, and any references listed on my application to provide the information below with regard to my employment.

 

This consent is valid for a period of six (6) months from the date indicated below.

 

Signature of Applicant:                                                                           Date:                                       

 

The individual named above has applied for employment with the Criminal Justice Institute, University of Arkansas System.  Please respond candidly to the requests for information listed below and return your written responses via either facsimile or U.S. Mail.  This Consent and Release is intended to comply with Arkansas Act 1474 of 1999, an Act to provide current and former business employers with protection for providing job information about current or former employers to prospective employers.

 

PLEASE RETURN THIS INFORMATION TO:

Criminal Justice Institute, University of Arkansas System, Attn: Human Resources, 7723 Colonel Glenn Road, Little Rock, Arkansas, 72204.  Phone:  501-570-8000   Fax:  501-565-3081

 

Date and Duration of Employment:
Current or last rate of pay and wage:
Current or last job description and duties:
The details of the applicant’s last written performance evaluation prepared prior to the date the
Applicant signed the consent:
Attendance history (excluding qualifying leave under FMLA):
Results of drug and/or alcohol tests administered within the last year:
Details of any threats of violence, harassing acts, or threatening behavior related in any way to the workplace or directed at another employee:
Details of applicant’s performance evaluation:
Was his/her separation from employment voluntary or involuntary?
What was the reason for the applicant’s separation from employment?

 

Is the applicant eligible for rehire?

 

 

 

State of Arkansas

Statement of Selective Service Status

In Compliance with Act 228 of the 1997 Acts of the Arkansas General Assembly

 

 

 

I understand that to be eligible for employment with the State of Arkansas, I must register, or be exempt from registration, with the Selective Service System in accordance with the Military Selective Service Act, 50 U.S.C. Appx. s.s. 451 et seq., as specified in Act 228 of the 1997 Acts of the Arkansas General Assembly.  I therefore swear or affirm under penalty of perjury that I have registered with the Selective Service system, or I am exempted from such registration because of one of the following provisions of the Military Selective Service Act or Act 228 of the 1997 Acts of the General Assembly: 

 

        I am female;

         I am a current member of the armed forces on active duty;

         I am under 18 years of age;

         I am 26 years of age or over;

         I am an exempted resident alien;

Other (please specify).                                                                                                 

 

 

 

 

Signature:                                                                                                         Date:                                       

 

 

 

Printed Name:                                                                                     

Affirmative Action Data Survey                                                                                                
In order to measure the effectiveness of the Criminal Justice Institute’s affirmative action program and to comply with the requirements set forth by the Equal Employment Opportunity Commission, applicant data must be collected concerning age, gender, race, and veteran status.  Completion of this form is optional and your application will not be affected if you chose not to participate.  The information will be maintained by the Criminal Justice Institute for reporting purposes only and will not be divulged to persons who participate in the interview and selection process.

Race:                    

 American Indian or Alaskan Native

 Black/African American          

 Hispanic

 Asian or Pacific Islander    

 White/Caucasian

 Other:                                           

 

Gender:            Male           Female

 

Veteran Status:  Please check all that apply.

Have you served at least six (6) years in the National Guard or U.S. Reserve, or have you been honorably discharged from active duty in the United States military, excluding Active Duty for Training and Reserve Military Annual Training?           Yes            No

 

Are you a spouse, widow or widower of such a veteran:                       Yes        No

 

 Vietnam Era Veteran*                     Other Veteran                                            *

 Disabled Veteran*                           US Citizen

 Over 40                                         If you are not an U.S. Citizen, what type of visa do you hold?
    Permanent         Temporary

 

*Veterans who voluntarily submit official proof of veteran status, disabled veteran status, or surviving spouse of a deceased veteran who remains unmarried at the time of application, and who are citizens and residents of the State of Arkansas, shall be entitled to employment preference in positions over other applicants after meeting substantially equal qualifications.  Applicants meeting this criteria should submit a DD-214, a current letter from the Veterans Administration and other appropriate documentation with your application.

 

How did you learn about this position?

 Personal contact      Requested information         Web site (address)                                                        

 Newspaper (Name of source)                                                                                                                         

 Professional publication (Name of source)                                                                                                       

 Job registry (Name of source)                                                                                                                         

 Other                                                                                                                                                              

 

Thank you for your participation.

 

 

 

 

 

 

 

 

 

THIS PAGE IS INTENTIONALLY BLANK.

 

 

 

 

CRIMINAL JUSTICE INSTITUTE---UNIVERSITY OF ARKANSAS SYSTEM

Employee Disclosure and Certification Form

 

The University of Arkansas Board of Trustees Policy 330.1, Employee and Contractor Conflict of Interest prohibits University transactions with or employment of persons that meet certain qualifying factors without the approval of a high-ranking University official.  To avoid either a possible violation of Board Policy 330.1 or the appearance of a conflict of interest, prior to hiring an individual, documentation must be submitted to the Director of the Criminal Justice Institute for review.  Approval to hire shall be considered in consultation with the Vice President for University Relations and Administration for the University of Arkansas System.

 

TO BE COMPLETED BY APPLICANT:

I understand that to be eligible for employment with the Criminal Justice Institute, University of Arkansas System, I must be in compliance with the University of Arkansas Board of Trustees Policy 330.1.  I therefore certify that:

1.       I have listed below if I am a current or former member of the Arkansas General Assembly, current or former constitutional officer, or state employee.

2.       I have listed below if my spouse, brother, sister, parent or child of me or my spouse is a member of the Arkansas General Assembly, a constitutional officer, or state employee.

3.       I understand that I cannot enter into any Professional Consulting Services Contracts with any state agency.

 

Indicate below if you, your spouse or the brother, sister, parent, or child of you or your spouse is a current or former member of the General Assembly, Constitutional Officer, or State Employee:

 

Position Held	Mark (Ö)		Name of Position or Job Held	Term(s) of Office or Dates of Employment		What is the person’s name and how are they related to you?  Indicate “self” if applicable.
	Current	Former		From	To	Name	Relation
General Assembly
Constitutional Officer
State Employee

        Check if none of the above applies

Name (please print):                                                       Social Security Number:                                                

Signature:                                                                     Date:                           

 

 

 

Under the provisions of the University of Arkansas Board of Trustees Policy 330.1, the following individuals cannot be hired without the review and approval of the Director:

(1)     members of the Arkansas General Assembly during their term of office,

(2)     constitutional officers during their term of office,

(3)     former members of the Arkansas General Assembly in any job created or enhanced by legislation in the two-year period immediately preceding the end of that person’s term of office,

(4)     former constitutional officers in any job created or enhanced by legislation in the two-year period immediately preceding the end of that person’s term of office, and

(5)     the immediate family member, including the spouse, of members of the General Assembly, constitutional officers, and state employees. 

 

 

APPROVAL:

 

Action:                           Approval                                Hold (pending additional request)

 

                                                                                                                                               

Criminal Justice Institute Director                                                    Date

 

Comments: