(Proof of U.S. Citizenship or immigration status will be required upon employment)
(Such a conviction may be relevant if job related, but does not bar you from employment)
List your last four (4) employers, assignments, or volunteer activities, starting with the most recent, including military experience.
Explain any gaps in employment in the comments section below. If you do not have any previous employment, please enter "not applicable in the required fields for the first employer.
List last three (3) schools attended, starting with the most recent.
List name and telephone number of three (3) business/work references who are not related to you and are not previous supervisors.
If not applicable, list three school or personal references who are not related to you.
(Exclude memberships that reveal sex, race, religion, national origin, age, ancestry, handicap, or other protected status.)
The information requested below will be used to comply with certain government record keeping and reporting requirements for the administration of civil rights laws and regulations.
In order to comply with these laws, we invite employees to voluntarily self-identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment.
The information will be confidential and will only be used in accordance with the provisions of applicable laws and regulations, including those that require the information to be summarized and report to the government for civil rights enforcement.
A person is Hispanic or Latino if he or she is Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with our without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary.
I give the Employer the right to investigate all references and to run a background check. I hereby release from liability the Employer and its representatives for seeking such information.
The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding and applicant’s consideration for employment on a basis prohibited by local, state, or federal law.
This application is current for only sixty (60) days. At the conclusion of that time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary for me to fill out a new application.
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