If you are under 18, and it is required, can you furnish a work permit? YesNo

    Have you ever been employed before? YesNo

    Are you legally eligible for employment in this country? YesNo

    Type of employment desired: Full-TimePart-TimeTemporarySeasonalEducational Co-op

    Are you able to meet the attendance requirements of the position? YesNo

    Have you ever pled “guilty” or “no contest” to, or been convicted of, a crime? YesNo

    Answering “Yes to these questions does not constitute an automatic bar from 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

    Equal access to programs, services & employment is available to all persons. Those applicants requiring reasonable accommodation
    to the application and/or interview process should notify a representitive of the Human Resources Department.
    Provide the following information for your past four (4) employers, assignments, or volunteer activities, starting with the most recent
    May we contact for reference? YesNo


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