Employment Application

Employment Application

Fields marked with a * are required.

Personal Information

Employment Desired


Special Skills and Additional Training

Please describe any special job-related skills or other qualifications that relate to the position for which you are applying. Do not include experiences which would indicate race, color, creed, religion, sex, ancestry, familial status, sexual orientation, national origin, marital status, Vietnam era veteran status, special disabled veteran status, status with regard to public assistance, membership or activity in a local commission, disability or age, family or ancestry.

Employment History

(Please begin with your current or most recent employer)

Employer #1

Employer #2

Employer #3

The following requested information is voluntary and confidential.  It will be kept separately from your application and any subsequent personnel file.  We collect this information for the sole purpose of creating and maintaining Equal Employment Opportunity and Affirmative Action records.  We appreciate your cooperation with our EEO/AA efforts.


An individual

a. who has a physical or mental impairment (condition) that materially or more major life activities; or

b. who has a record of such impairment; or

c. who is regarded as having such an impairment

Major life activities may include such activities as caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, sitting, standing, lifting, breathing, leaning and working.

By submitting, I Agree...

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing the same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date and payment of my wages and salary, be terminated at any time without prior notice and without cause.”