LaPorte County Council

Human Resources
555 Michigan Avenue, Suite 101
LaPorte, IN 46350
Phone: 219-326-6808 Ext. 2203
Fax: 219-362-3093

An Equal Opportunity Employer

LaPorte County Online Application Process

If you wish to also submit a resume, click here!

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

SUMMARY
LaPorte County is an Equal Employment Opportunity Employer. Applicants are considered for employment without regard to race, religion, color, national origin, sex, age, disability, veteran status, genetic information, or any other basis prohibited by law.
PERSONAL DATA
*Name (Last, First, M.I.):
*Address 1:
Address 2:
*City:
*State:
*Zip Code:
*Primary Phone:
Alternate Phone:
*Email Address:
APPLICATION FOR EMPLOYMENT
Employment Desired
*Position(s) you are applying for: *Hourly rate/salary desired:
*Have you ever been employed with LaPorte County Government?
If yes, please provide date of employment and position held below:
*Date Available to Start:
*Will you accept: Temporary Work Part Time Work Shift Work
*Are you at least 18 years of age: If no, age:
*Are legally eligible to be employed in the United State? (Proof of eligibility will be required upon employment)
*Do you currently posses a valid driver's license?
*Is your license restricted or suspended?
EDUCATION / TRAINING
Education
*Do you have a high school diploma or GED?
If you do not have a high school diploma or GED, what is the highest grade completed?
*High School name or GED institution:
*Location of school, City/State:
School Name & Location Name & Location Course/Major Studied Years Completed Type of Degree Credits Completed
College/University
Graduate/Professional
Vocational/Other
LICENSE / REGISTRATION / CERTIFICATE
List any required professional license, registration, certificate, CDL, ect.
Description State Number Expiration
SPECIALIZED SKILLS & KNOWLEDGE
List skills or knowledge that shows your ability to perform the job for which you are applying (such as key boarding speed, computer languages, software programs, ect.
WORK HISTORY

List your employment history beginning with the most recent. Include full or part-time, Military, summer jobs, ect.

*May we contact your present/past employer(s):

EMPLOYER 1
Name of Employer Employer's Address Employer Phone
Your Job Title Supervisor Name/Title/Phone Number  
Start/End Date Starting/Ending Salary Was Position:
From:
To:    
Start:
End: 
Reason for Leaving
Duties
EMPLOYER 2
Name of Employer Employer's Address Employer Phone
Your Job Title Supervisor Name/Title/Phone Number  
Start/End Date Starting/Ending Salary Was Position:
From:
To:    
Start:
End: 
Reason for Leaving
Duties
EMPLOYER 3
Name of Employer Employer's Address Employer Phone
Your Job Title Supervisor Name/Title/Phone Number  
Start/End Date Starting/Ending Salary Was Position:
From:
To:    
Start:
End: 
Reason for Leaving
Duties
EMPLOYER 4
Name of Employer Employer's Address Employer Phone
Your Job Title Supervisor Name/Title/Phone Number  
Start/End Date Starting/Ending Salary Was Position:
From:
To:    
Start:
End: 
Reason for Leaving
Duties

REFERENCES

*List 3 persons who are not related to you and who would have knowledge of your qualification for the position(s) for which you are applying, such as former co-workers, teachers, etc. Do not repeat names of supervisors listed under experience.

Name Address Telephone Email Occupation
MILITARY
*Have you ever served in the Armed Forces? If yes, which Branch of Service:
Period of Duty: Started Ended:
Rank at Discharge: Date of Final Discharge:
GENERAL INFORMATION
*“ Have you ever been convicted of a felony?
If yes please list the following information for each offense (Conviction type, Date, Location and Offense):
Please Note: A conviction does not automatically mean you cannot be hired/appointed. What you were convicted of, and how long ago, are important. Give all facts so that a decision can be made.
ACKNOLEDGMENT AND AUTHORIZATION TO RELEASE INFORMATION

I certify that answers given herein are true and complete to the best of my knowledge.

I, authorize LaPorte County Government and its designated representatives to conduct an appropriate background investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision and authorize any person who may have information relative to this investigation to disclose same. I also release any person from ay form of liability for such disclosure.

As part of the County's procedure for processing your employment application, a background investigation will be conducted and your personal and employment references may be checked. Any Credit Bureau, Retain Merchants Association, Banks, Financial Institution, or Credit Extending Organization. Any Department of a city, county, state or Federal Government, or its agency. Any Doctor, Hospital or medical clinic. Any Principal, Dean, Counselor or authorized person at a College, University, School, Trade School or learning institution. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job.

In the event of employment, I understand that false or misleading information given in this application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the US, have a physical examination and/or drug test, or sign a conflict of interest agreement and abide by its terms.

I Understand and agree to the information shown above:

Digital Signature:
Digital signature is your full name spelled out followed by the last 4 of your SSN
Date:
DIVERSITY INFORMATION

This employer has requested Equal Employment Opportunity/Affirmative Action (EEO/AA) demographic information as part of their application process. Providing this information is strictly voluntary. Select 'Decline to Identify' if you do not wish to provide it. The law prohibits employers from taking any adverse action against you if you choose not to provide this information.
*


Ethnicity (Revised 2007 Values)
  • Hispanic or Latino a person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race.
  • White (not Hispanic or Latino) a person having origins in any of the original people of Europe, the Middle East, or North Africa.
  • Black or African American (not Hispanic or Latino) a person having origins in any of the black racial groups of Africa
  • Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) a person having origins in any of the original People of Hawaii, Guam, Samoa, or other Pacific Islands.
  • Asian (not Hispanic or Latino) a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
  • American Indian (not Hispanic or Latino) a person having origins in any of the original peoples of North or South America (including Central America), and who maintains tribal affiliation or community attachment.
  • Two or More Races (not Hispanic or Latino) all persons who identify with more than one of the above races.
Ethnicity: Gender:

If any errors, they will be shown above.