General Information


    Employment Information

    If no, why?

    If yes, dates and positions.

    If yes, dates and positions.

    These questions are not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

    If yes, dates and positions.


    Employment History

    Please include employment for the past 10 years.

    Most Recent Position


    Next Most Recent Position


    Next Most Recent Position

    Skills and Qualifications

    Please summarize any special training, skills, licenses, and/or certifications that may assist you in performing the duties of the position for which you are applying.

    Professional Skills

    Please indicate areas of proficiency as applicable to the desired position.


    Please provide three business/professional references who are not related to you and not previous supervisors. If not applicable, please list three school or personal references not related to you.

    Educational/Training Background

    Please provide all relevant educational and training background, including certifications and professional licenses.


    Please read carefully before signing.

    I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

    I understand that Yuma County may conduct a background investigation and that Yuma County will provide for me a separate form authorizing the completion of such an investigation prior to completion.

    I authorize Yuma County and/or any of its agents to verify and investigate any or all statements contained in this application. I also authorize any person, school, employer, law enforcement authority, or organization named in this application to provide and release any information and opinions concerning my background. I release such persons and organizations from any legal liability for any damage whatsoever for making such statements.

    I understand that employment decisions at Yuma County are made on a merit basis and are not influenced by race, color, national origin, ancestry, creed, religion, sex, age, physical or mental disability, sexual orientation, or any other similarly protected status.

    I understand the use of illicit drugs is prohibited during employment. I may be required to successfully pass a drug and alcohol screening examination prior to being hired and consent to taking a drug and alcohol test at any time during my employment should I be hired.

    I understand that this application or any subsequent employment does not constitute a contract of employment nor guarantee employment for any definite period of time.