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  • APPLICATION FOR EMPLOYMENT

  • GENERAL INFORMATION

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  • JOB INTEREST

  • Important Information Relating to above question

    This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

  • Background

    Answering “yes” to either of the following questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

  • Employment History Information

  • Work History: Current and previous 2 employers (most current employer listed first)

    Start with your present or most recent job and work backward.  You may exclude employment which indicates race, color, gender, national origin, disabilities or other protected status.

     

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  • NEXT EMPLOYER

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  • NEXT EMPLOYER

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  • EDUCATION INFORMATION

  • HIGH SCHOOL

  • COLLEGE OR UNIVERSITY

  • Graduate School

  • VOCATIONAL/OTHER

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  • I certify that all the information I have provided in order to apply for and secure work with this employer is true, complete and correct.  I understand that if any  false or misleading information, omissions or misrepresentations are discovered, it will be sufficient cause to (a) eliminate me from further consideration for employment and/or (b) may result in my immediate discharge from the employer’s service, whenever it is discovered. 

    I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional) employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview.  I hereby waive any and all rights and claims I may have regarding the employer, it agents, employees or         representatives for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. 

    I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or disqualifying any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. 

    I understand that this application remains current for only 90 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 reapply and fill out a new application. 

    I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

    It is the policy of the Company to provide equal opportunity with regard to all terms and conditions of employment.  This Company does not tolerate unlawful discrimination in its employment practices.  No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, sex, national origin, citizenship, age, disability, veteran status or any other protected status under applicable federal, state or local law.

  • Important:

    DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT! I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
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