Application For Employment Court Of Justice
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4AOC-001-3
APPLICATION FOR EMPLOYMENT
Post ID – Job Title
Rev. 12-08
Court of Justice
Name-Location for
which you are applying
l e x
e t
An Equal Opportunity Employer
j u s t i t i a
___________________
Accommodations are available for applicants with disabilities in all phases of the application and employment process.
To request an accommodation please contact the ADA Coordinator at 502-573-2350 or ADACoordinator@kycourts.net.
Resumes without a completed application will not be considered.
Personal Information
_________________________________________________________________________________________________
Last Name
First Name (legal name) Middle Name
Preferred Name
_________________________________________________________________________________________________
Street/Rural Route /PO Box
Apt. Ste or Apt. Box #
City
State
Zip Code (zip last 4 digits)
Home County _______________________________
Primary Phone __________________________
Email Address _______________________________
Secondary Phone ________________________
Driver’s License State _________________________
Driver’s License No ______________________
Are you over the age of 16? ______
If hired, could you provide documentation that you are
legally eligible to work in the United States?
_________
Commonwealth Employment Status
____
I have retired from an agency under the Kentucky Retirement System (e.g. KRS, CERS, KTRS)
Branch/Agency Department _______________________________ Last Year of Employment _______
____
I am currently/previously employed by an agency under the Kentucky Retirement System
(If multiple agencies, list most recent agency below)
Branch/Agency Department _______________________________ Last Year of Employment _______
Years of service ________________ Are you currently employed by this agency? __________
If currently employed, are you serving a disciplinary probation? ________
____
I have never been employed by an agency under the Kentucky Retirement System
Certifications
1. Date Certified _______________ Date Expiration _________________ Certification Number ____________________
Profession ____________________________ Licensing Agency ___________________________________________
_______________________________________________________________________________________________
Agency Address and Telephone Number
2. Date Certified _______________ Date Expiration _________________ Certification Number ____________________
Profession ____________________________ Licensing Agency ___________________________________________
_______________________________________________________________________________________________
Agency Address and Telephone Number
Criminal History
Failure to disclose any convictions shall result in an automatic rejection of application and any offer of employment.
A conviction is the act or process of judicially finding someone guilty of a crime; the state of having been proven guilty.
If applicable, list all convictions, including traffic violations. A conviction is not an automatic rejection. Specifics will be
reviewed.
1. Date Convicted __________ State Convicted ______________
Details ___________________________________________________________________________________________
2. Date Convicted __________ State Convicted ______________
Details ___________________________________________________________________________________________
3. Date Convicted __________ State Convicted ______________
Details ___________________________________________________________________________________________
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