Application For Employment

EQUAL OPPORTUNITY EMPLOYER. It is our policy to abide by all federal, state and local laws prohibiting employment discrimination based solely on a person’s race, color, religious creed, sex, national origin, ancestry, citizenship status, pregnancy, childbirth, physical disability, mental disability, age, military status or status as a Vietnam-era or special disabled veteran, marital status, registered domestic partner or civil union status, gender (including sex stereotyping and gender identity or expression), medical condition (including, but not limited to, cancer related or HIV/AIDS related), genetic information, sexual orientation, or any other protected status except where a reasonable, bona fide occupational qualification exists.
  • Personal Information

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  • POSITION/AVAILABILITY:

  • If part-time, specify hours and days available
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  • EDUCATION:

  • ** Only list colleges or universities accredited by the Department of Education (DOE). The DOE maintains a database of accredited institutions at http://ope.ed.gov/accreditation. It is your responsibility to verify accreditation.
  • Professional Licenses/Certifications

    List course work undertaken or degree/diploma received from an unaccredited college, as well as any other education, training, special skills. or certificates/licenses that you possess related to the job.
  • General Information

  • Employment History

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  • Previous Employment



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  • Previous Employment

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  • Previous Employment

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  • CRIMINAL RECORD INFORMATION (Instructions for answering the next two questions below):
    A. All Applicants. Do not include convictions that were sealed, eradicated, erased, annulled by a court, expunged, pardoned, or deferred and
    withdrawn.
    B. District of Columbia, Illinois, and Rhode Island Applicants. Do not respond to the second question (regarding pending charges).
    C. California Applicants. Do not include: a misdemeanor conviction for possession or transportation of a small amount of marijuana (28.5 grams or less) if the conviction is more than two (2) years old; participation in any pretrial or post trial diversion program for drug or alcohol rehabilitation; or a misdemeanor conviction for which probation was successfully completed or otherwise discharged and the case was judicially dismissed.
    D. Colorado Applicants. Exclude information involving any record of civil or military disobedience unless such matters resulted in a plea of guilty or a conviction by a court of competent jurisdiction.
    E. Connecticut Applicants. You are not required to disclose the existence of any arrest, criminal charge, or conviction, the records of which have been erased. Criminal records subject to erasure are: records pertaining to a finding of delinquency or the fact that a child was a member of a family with service needs; an adjudication as a youthful offender; a criminal charge that has been dismissed or nulled (not prosecuted); a criminal charge for which the person was found not guilty; or a conviction for which the offender received an absolute pardon. Any person whose criminal records have been erased is deemed to have never been arrested within the meaning of the law as it applies to the particular proceedings that have been erased, and may so swear under oath.
    F. Hawaii Applicants. Do not answer the following two questions.
    G. Massachusetts Applicants. Do not answer the following two questions.
    H. Michigan Applicants. Regarding pending charges, limit your response to felony offenses.
    I. Utah Applicants. Regarding convictions, limit your response to felony convictions. Do not respond to the second question (regarding pending charges).
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