Harlow Employment Application

Educational Background

List up to three schools starting with the latest.
School Name
Years Completed
Degree/Diploma
Class Rank / GPA
Major
Minor
Would you like to add another educational institution?

YesNo
School Name
Years Completed
Degree/Diploma
Class Rank / GPA
Major
Minor
Would you like to add another educational institution?

YesNo
School Name
Years Completed
Degree/Diploma
Class Rank / GPA
Major
Minor

Foreign Languages

List any foriegn languages skills that you posess.
Please list the language, if you read & write, read & speak, read only, or speak only.

Employment Data Record

Employees are treated during employment without regard to race, color, religion, sex, national origin, age, martial or veteran status, medical condition or handicap, or any other legally protected status.

As an employer with an Affirmative A

Action Program, we comply with government regulation, including Affirmative Action responsibilities where they apply.

The purpose for this Data Record is to comply with government record keeping, reporting and other legal requirements. Periodic reports are made to the government on the following information. The completion of this data record is optional. If you choose to volunteer the requested information, please note that all Data Records are kept in a Confidential File and are not part of your Application for Employment or personnel file.

Please note: YOUR COOPERATION IS VOLUNTARY. INCLUDSION OR EXCLUSION OF ANY DATA WILL NTO AFFECT ANY EMPLOYMNET DECISION.

VOLUNTARY SURVEY

Government agencies at times require periodic reports on the sex, ethnicity, handicap, veteran and other protected status of employees. This data is for statistical analysis with respect to the success o the affirmative action program.

SUBMISSION OF THIS INFORMATION IS VOLUNTARY.
Date of Application

MonthDayYear
Date
Complete the sections below
Current Job
Social Security Number
Date of Birth

MonthDayYear
Date
Please check one of the following:

WhiteBlackHispanicAmerican Indian / Alaskan NativeAsian / Pacific IslanderOther
Check if any of the following are applicable:

Vietnam Era VeteranDisabled VeteranHandicapped Individual
Applicant's Statement

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

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

The applicant understands that neither this document nor any offer of employment from the employer constitute an employment contract unless a specific document to that affect is executed by the employer and employee in writing.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may results in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Current Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty: