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2. COUNTY OF YAKIMA PERSONAL HISTORY STATEMENT
   Application must be completely filled out. If not applicable please fill blank with N/A. *Please include a current resume with your application.
4. 1. PERSONAL
6. First Name*
7. Middle Initial*
8. Last Name*
10. Date of Birth*
    Date of Birth
11. Enter all other names used.
13. Address*
14. City*
16. State*
17. Zip Code*
18. Phone Number*
20. Email Address*
22. In case of emergency contact - include name, phone number and relationship.
24. Are you related to or know any Yakima County employees? *

    1. Yes
    2. No
25. If yes, please list names of Yakima County employees that you are related to or know.
27. 2. EDUCATION
29. Are you currently a student*

    1. Yes
    2. No
30. If yes, where are you attending? If no please list approximate date and last school attended.*
32. If you are a student attending college, are you requesting that your college/university grant you credit for your internship?

    1. Yes
    2. No
34. 3. LEGAL
36. Have you ever been arrested or convicted for any crime (DO NOT include traffic infractions.)*

    1. Yes
    2. No
38. If yes, please give the following information:
40. Approximate Date: *
41. Police Agency: *
43. Circumstances: *
45. Approximate Date: *
46. Police Agency:*
48. Circumstances: *
50. Have you ever been on probation?*

    1. Yes
    2. No
52. If yes, please give details, (including when, where and why)
54. Approximate Date: *
55. Circumstances:*
57. Approximate Date: *
58. Circumstances:*
60. 4. REFERENCES
62. In the spaces below, please list, as references, two (2) individuals who have knowledge of you and your qualifications.
64. First Name
65. Last Name
67. Phone Number*
68. Email Address
70. First Name
71. Last Name
73. Phone Number*
74. Email Address
76. Please incude a current resume*
78. Please include your most recent college transcript. *
80. By typing your name below, you are acknowledging that the information contained in this application is true and accurate. *
Leave This Blank:


82. 1. Receive an email copy of this form.
83. Email address

    This field is not part of the form submission.

84. Submit

* indicates a required field