Central Iowa Juvenile
Detention Center

 

Online Application

If your browser does not support this online form please download the application and email it to applications@cijdc.com

Applicant: We appreciate you interest in our organization. Please fill in all blanks.

All Fields wtih * are Requried to Process Application

Date*

I. PERSONAL INFORMATION

Name




First *
Full Middle *
Last *
Email *
     
Name that you go by if different than your first name ie. Joe instead of Joseph
         



Home Phone
Cell Phone*
Work
County of Residence


*Required For DPS Check
Social Security#*
Driver License# *
Date of Birth *
Gender *
Do you have Valid Drivers' License?*
Drivers' License State*
Present Address



Street
City
State
Zip
Permanent Address




Street
City
State
Zip
Position
Are you Bilingual?
 If Yes what Language(s)?
Employment Status
   
** Masters Level Only
Are you Independently Licensed?
License Issues By:
 
License Type:
License Expiration Date:
All Hours That You CANNOT Work At Central Iowa Detention.
Do Not List Current Job Schedule If You Plan To Resign If Offered a Position at Central Iowa Detention.
If you are a College Student Please List Class Schedule in this Section.
Monday
Friday
 
Tuesday
Saturday
 
Wednesday
Sunday
 
Thursday
Date Available to Start:
 
         
How did you learn of this position? Please List Name  

II. EDUCATIONAL BACKGROUND
College Attended
Last Year Completed
Name
City
(1,2,3, or 4)
Did You Graduate?
Major
Degree Completed
Minor
College Attended
Last Year Completed
Name
City
(1,2,3, or 4)
Did You Graduate?
Major
Degree Completed
Minor
         

III. PROFESSIONAL REFERENCES
 
Name
Phone
Relationship
Employer
Job Title
1
2
3
Please list how proficient you are in each of the following:*
Word Excel Outlook Internet
List additional experience, certifications and what skill set you will bring to the position.

IV. EMPLOYMENT HISTORY
Current OR Most Recent
Employer
Company Name
Position
City
Telephone
Start Date*
Thru*
Hourly Rate *
Hrs/Wk*
Annual Salary*
Current Work Schedule
Supervisor
Supervisor's Title
Describe Duties Performed
Reason for Leaving:
May we contact this employer? If "No," Why?
Previous Employer
Company Name
Position
City
Telephone
Start Date
Thru
Hourly Rate
Hrs/Wk
Annual Salary
Supervisor
Supervisor's Title
Describe Duties Performed
Reason for Leaving:
May we contact this employer? If "No," Why?
Internship
Company / Agency
 
Start Date:
End Date
Supervisor
Volunteer
Company / Agency
Work
Start Date:
End Date
Supervisor

V. MILITARY SERVICE RECORD

Were/Are you in the U.S. Armed Forces?
Branch Rank
Type of Discharge    
If Less than Honorable, Explain    


VI. DPS/DEPARTMENT OF HUMAN SERVICES CHECK

 

 

Have you ever been convicted of an offense in adult court? If "Yes" list offense(s) and DATE(S) of each offense:
How many moving violations have you had in the last 36 months? Please list the moving violations
Have you ever had a founded child abuse report with the Department of Human Services?
   
   


I understand that prior to beginning employment at Central Iowa Juvenile Detention Center, the administrative code of Iowa requires clearance from the Child Abuse Registry and from the Department of Public Safety. I voluntarily consent to these confidential investigations. I understand that records which indicate child abuse will prevent my employment at Central Iowa Juvenile Detention Center, and any other juvenile detention facility.

Required Information for DPS Check: Maiden Name (and/or any alias names):

I hereby affirm that the information provided above is accurate to the best of my knowledge. I understand that if employed, false statements on this application shall be considered sufficient cause for immediate dismissal. Offer of employment is contingent upon a successful drug screening and physical examination
Electronic submission of this application substitutes for signature.