Employment Application

Application Data

Programs, services, and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview.

Answering “yes” to these question does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be considered.

Previous employment (begin with most recent position)
Employment 1
Employment 2
Employment 3

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of personal, employment, educational, financial, and other related matters as may be necessary for an employment decision.

I herby release employers schools or individuals from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.


List three (3) references that are not related to you by blood or marriage who can comment on your education or work experience:

Reference 1
Reference 2
Reference 3

If you are claiming preference under the Veterans’ Employment Preference Act or Handicapped Persons’ Employment Preference Act, complete the following.