Fillable Printable Judicial Branch Employment Application
Fillable Printable Judicial Branch Employment Application
Judicial Branch Employment Application
NHJB-2099-DFPS (09/23/2013) Page 1 of 5
Be sure you have filled in the identifying information at the top of this application.
Do not write in the space marked “For Official Use Only”
Will you accept those which apply (check): full-time part-time temporary
Please check up to three counties in which you will a c cept employment: - Check none if you will accept employment statewide.
Merrimack Belknap Hillsborough Rockingham Cheshire Coos Strafford Sullivan Grafton Carroll
If the position require s a license or special certification, please com plete the following:
Type of License or Certificate License/Certificate # Expiration Date
DO YOU HAVE THE LEGAL RIGHT TO ACCEPT EMPLOYMENT IN THE UNITED STATES?
Yes No
Are you at least 18 years of age?
Yes No Are you able to travel, if so required ? Yes No
Have you been employed by the Court/ State before?
Yes No If yes, when
For what Court/Agency/Departme nt were you employed? In what position?
Perm. Temp. Full-time Part-time What was your reason for leaving?
IF YOU HAVE EVER BEEN CONVICTED OF A CRIME (FELONY OR MISDEMEANOR) THAT HAS NOT BEEN OFFICIALLY ANNULLED BY A COURT, YOU
MUST COMPLETE THE FOLLOWING SECTION, GIVING THE DATE, LOCATION AND NA TURE OF THE FELONY OR MISDEMEANOR CONVICTION.
If you leave this space blank, you are certi fying that you have no current record o f conviction.
Please Note: Conviction is not an automatic disqu alifier for employment. Each case i s considered individually.
WILLFUL OMISSION OR MISREPRESENTATION OF REQUIRED INFORMATION WILL BE BASIS FOR REJECTION OF YOUR APPLICATION.
PLEASE COMPLETE THIS SECTION FIRST
Name*:
LAST
FIRST MIDDLE
POSITION FOR WHICH YOU ARE APPLYING*
Address*:
MAILING ADDRESS
HOME PHONE* POSITION NUMBER
CITY
STATE ZIP CODE
ALTERNATIVE PHONE COURT NAME
Email:
* Required
NEW HAMPSHIRE
Judicial Branch
The State of New Hampshire is an equal opportunity employer
FOR OFFICAL USE ONLY:
Internal Hire
Discrimin ation on the basis of age, sex, race, colo r, marital status, physical o r mental disabilit y,
religious creed, national origin, sexual orientation or any other non-merit factor is strictly prohibited.
ONLINE APPLICATION FOR EMPLOYMENT
NHJB-2099-DFPS (09/23/2013) Page 2 of 5
EDUCATION
Please enter the highe st school grade completed: (8 – 9 – 10 – 11 – 12 or GED – 13 – 14 – 15 – 16 – 17 – 18)
Are there any specialized courses you have taken which should be considered with this application? Please explain below.
College, Business, Tra de School, Other Education. TRANS CRIPTS MUST BE SUBMITTED IF POSITION REQUIRES POSTSECONDARY EDUCATION
(photocopies accepted for certification purposes )
Name of School Major Minor Degree or Certificate Earned Year
EXPERIENCE – WORK HISTORY
Please start with most recent or current employer and work back at least ten years. Resumes may be submitted, but not in lieu of completing this section. If more
space is needed, please complete and attach a separate page. Incomplete employment history and/or statements such a s “refer to resume” or failure to complete
all required fields will be cause for disqualification*.
Employer*: Address: Phone*: ( )
Your Job Title*: Supervisor (Name/Title)*:
Date of Employment*: Mo. Year to Mo. Year Hours worke d per week May we contact? Yes No
Duties: Please describe your responsibilities*:
How many employee s did you supervise? Did you assign their work? Yes No Reject unsatisfactory work? Yes No
Did you have the authority to hire/fire? Yes No Reason you left this position:
Employer: Address: Phone: ( )
Your Job Title: Supervisor (Name/Title):
Date of Employment: Mo. Year to Mo. Year Hours worked per week May we co ntact? Yes No
Duties: Please describe your position responsibilities:
How many employee s did you supervise? Did you assign their work? Yes No Reject unsatisfactory work? Yes No
Did you have the authority to hire/fire? Yes No Reason you left this position:
NHJB-2099-DFPS (09/23/2013) Page 3 of 5
Employer: Address: Phone: ( )
Your Job Title: Supervisor (Name/Title):
Date of Employment: Mo. Year to Mo. Year Hours worke d per week May we contact? Yes No
Duties: Please describe your position responsibilities:
How many employee s did you supervise? Did you assign their work? Yes No Reject unsatisfactory work? Yes No
Did you have the authority to hire/fire? Yes No Reason you left this position:
Employer: Address: Phone: ( )
Your Job Title: Supervisor (Name/Title):
Date of Employment: Mo. Year to Mo. Year Hours worke d per week May we contact? Yes No
Duties: Please describe your position responsibilities:
How many employee s did you supervise? Did you assign their work? Yes No Reject unsatisfactory work? Yes No
Did you have the authority to hire/fire? Yes No Reason you left this position:
Employer: Address: Phone: ( )
Your Job Title: Supervisor (Name/Title):
Date of Employment: Mo. Year to Mo. Year Hours worke d per week May we contact? Yes No
Duties: Please describe your position responsibilities:
How many employee s did you supervise? Did you assign their work? Yes No Reject unsatisfactory work? Yes No
Did you have the authority to hire/fire? Yes No Reason you left this position:
Employer: Address: Phone: ( )
Your Job Title: Supervisor (Name/Title):
Date of Employment: Mo. Year to Mo. Year Hours worke d per week May we contact? Yes No
Duties: Please describe your position responsibilities:
How many employee s did you supervise? Did you assign their work? Yes No Reject unsatisfactory work? Yes No
Did you have the authority to hire/fire? Yes No Reason you left this position:
NHJB-2099-DFPS (09/23/2013) Page 4 of 5
I have attached a copy of my current resume.
I understand that in order for my application to be considered, the following Affirmation MUST BE COMPLETED.
I certify the information provided in or attached to this application is complete, accurate and up-to-date on the date specifi ed belo w. I certify that I have the legal
right to accept employment in this state, and that I will produce, at or before the date of hire, proof of that right to accept employment. I further certify that there are
no willful misrepresentations of the above statement and the answer to the question herein, and that I have made no omissions of material fact with respect to any
of my answers to the questions pre sented. I understand that if an investigation should disclose su ch misrepresentation or omission s, my application may be
rejected. Finally, I underst and that if I should be employed at the time of such investigation and disclose r, my service may be immediately terminated. I
understand that I may be required to sign a facsimile of this form before I may begin employment in this or a ny other po sition.
By checking this box, you are certifying that you have read and agreed to the above statement
SIGNATURE: DATE:
(Each application must bea r a current date and original signature.)
UNLESS OTHERWISE SPECIFIED, APPLICATION SHOULD BE
RETURNED TO:
ADMINISTRATIVE OFFICE OF THE COURTS
TWO CHARLES DOE DRIVE
CONCORD, NEW HAMPSHIRE 03301
Telephone: (603) 27 1-2521
Fax number: (603) 51 3-5454
Email: applicatio[email protected]e.nh.us
RECRUITMENT/EMPLOYMENT SURVEY
Please check one of the following to assist in our recruitment efforts.
I learned of this career op portunity through:
Private Employment Agency Radio/TV advertisements
Opportunities in NH State In-house posting within my agency
Job-Fair NH Division of Personnel
NH Employment Security Judicial Branch web site
JobsInNH.com Newspaper (plea se name):
Other (please specify)
NHJB-2099-DFPS (09/23/2013) Page 5 of 5
State of New Hampshire - Administrative Office of the Courts
Equal Employment Oppo rtunity Survey
As part of its mandate under Title VII of the Civil Rights Act of 1964, the federal Equal Employment Opportunity Commi ssion require s periodic repo rts from state
governments which indicate the composition of their applicant and work force by age, gender and ethnic/race category based on spe cific job categories
(professional, technical, administrative, management etc). Your responses are Strictly Voluntary, will be kept Confidential and separated from all other
personnel records only accessed by the Human Resources Department. No adverse treatment will result if you choose not to answer any of the questions.
SOCIAL SECURITY NUMBER: ___ ___ ___ - ___ _ __ - ___ ___ ___ ___
AGE: (In whole numbers)
JOB TITLE of position for which you are applying:
POSITION NUMBER of position for which you are applying:
GENDER: (Please check only one response be low)
Male Female
ETHNICITY: (Please check only one response below)
H = Hispanic or Latino: A person of Cuban, Mexica n, Puerto Rican, South or Central American, or other Spanish culture or origin regardl ess of race.
YES NO
RACE: (Please check only one response below)
W = White (Not Hisp anic or Latino) A person having origins in any of the original peoples of Europe, the Middle East or North Africa.
B = Black or African American (Not Hispanic or La tino) A person having origins in any of the black racial groups of Africa.
NHOPI = Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) A pers on having origins in any of the peoples of Hawaii, Guam,
Samoa or other Pacific Islands.
A = Asian (Not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, South east Asia or the Indian
Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malay sia, Pakistan, the Philippine Islands, Thail and and Vietnam.
AIAN = American Indian or Alaska Native (Not Hispanic or Latino) A person hav i ng origins in any of the original peoples of North and So uth
America (including Central America) and who maintain tribal affiliation or community attachment.
T = Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above five races.
Please check all that apply:
W B NHOPI A AIAN
Date completed:
Thank you for your participation.
PLEASE RETURN COMPLETED FORM TO:
Administrative Office of the Courts
Human Resources Dept.
2 Charles Doe Drive
Concord, NH 03301
