USVI Legislature Job Application Form

Job Application

Legislature of the US Virgin Islands
Today's Date*

MonthDayYear
Full Name*

First NameLast Name
E-mail
example@example.com
Phone Number*
Are you currently residing in the US Virgin Islands?*

Yes, St. ThomasYes, St. JohnYes, St. CroixNo, I'm currently off island but interested in relocating
I am applying for:*

Legislative Reporter/StenographerCustodian (St. Thomas/St. John)Legislative Clerk (St. Thomas/St. John)Social Media Specialist (St. Croix)
Desired Salary/Hourly Rate*

Military Service
Have You Served in the US Military?*
If eligible, Do you claim Veteran's Preference?*
If Yes, were you honorably discharged? *
Military Service Dates
Do you have a service Disability (rated 10% or more by the V.A)? *
As needed, are you able to provided a copy of your DD214 and other relevant military documents?*

Address Section
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
My Physical and Mailing address are the same, ____.*

YesNo
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Availability
If offered, please state the earliest date you are available to work*

MonthDayYear
If offered, how much notice would you need to provide your current employer*

N/A2 weeks1 Month+
Please List the dates of any pre-scheduled trips you may have for the next 12 months
Are you interested in working FT/PT/On-Call/Temporary/Any?*

Full-TimePart-TimeOn-CallTemporaryTemporary-to-HireAny
What days of the week are you most interested in working?

Weekdays (Monday-Friday)Weekends (Saturday & Sunday)Any day of the week
What Times of Day Are You Most Interested In Working?

MorningsAfternoonsEveningsAny Shifts
Positions may require working shifts outside of normal working hours & weekend shifts depending on the needs of the operation*

Yes, I can work flexible shifts/weekends if neededNo, I may not be available for flexible shifts/weekends
If required by the position, please describe your willingness to travel*

No, I'm not willing to travelYes, I'm willing to travel by car, boat or plane

Please Indicate your typical Availability

	AM	PM	Available Any Time	Exact Times	Typical 8am-5pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Reasonable Accommodations
Are you able to complete the functions of the position with or without reasonable accommodation?*

YesNo
This position may or may not require heavy lifting/pushing/pulling/twisting of up to 50lbs, sitting/standing for extended periods, the use of stairs etc. Are you able to complete the functions of the position if they require the aforementioned with or without reasonable accommodation?*

YesNo
Are there any 'Reasonable Accommodations' that you require of the employer for the job in which you are applying?*

YesNoI prefer not to disclose
As Applicable, List any needed Reasonable Accommodations (Optional) *

Background Questions
Have you ever been convicted of any crime in the last 7 years?*

YesNo
If Yes, Please Explain*
List Any Felonies (including First Degree Misdemeanors) and the location of the Conviction
Date of Conviction*

MonthDayYear
Date
Were you ever convicted of a sexually violent offense or sexually criminal offense against a minor?*

YesNo
If Yes, Please Explain*
List Any Felonies (including First Degree Misdemeanors) and the location of the Conviction
If Yes, in accordance with Act#6182, have you registered with the VI Department of Justice and can provide evidence of this registration?*

YesNo
Date of Sex Crime Conviction*

MonthDayYear
Date
Do you wish to disclose any allergies?*

YesNo
If Yes, Please State

Education Section
EDUCATION/WORK HISTORY / EXPERIENCE

Please list your 3 most current work history/experience
Education Level*
Name of School/Institution
Date of Graduation

MonthDayYear
Date
Please List any special certifications you may have
Knowledge of Skills and Abilities (KSA's) **List Relevant Skills you possess relevant to the position you are applying**

References

Acknowledgments
Policy Acknowledgments: False information, Omission, Misstatement, Misrepresentations will cause removal of your application from the consideration process or termination of employment if discrepancies are discovered at any time post-hire.

I am aware that any omission, falsification, misstatement, or misrepresentations above may disqualify me for employment consideration and if I am hired, may be grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I consent to the release of information about my ability, employment history, and fitness for employment by employers, school, law enforcement agencies, and other individuals and organizations to investigators, personnel staff, and other authorized employees of the Virgin Islands Government for employment purposes. I understand and accept the fact that my consent shall remain effective during the tenure of my employment should I be hired. I understand that applications submitted for Government employment are public records. I certify that to be the best of my knowledge and belief all of the statements contained herein and on any attachment are true, correct, complete, and made in good faith.
I hereby acknowledge all the aforementioned USVI Legislature policies and certify that all information provided on my application is true and accurate to the best of my knowledge and made in good faith. *
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