Application For Employment

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ADDITIONAL INFORMATION CONT.

The information requested is needed for legally permissible reason, including, without limitation, national security considerations, legitimate occupational qualification or business necessity. The Civil Right Act of 1964 prohibits discrimination in employment because of race, color, religion, sex, or national origin. Federal law also prohibits discrimination based on age, citizenship and disability. The laws of most states also prohibit some additional types of discrimination based upon ancestry, marital status, and sexual preference.

Driver's License

Do you have a valid driver's license:

Do you have current vehicle insurance:

Are there any restrictions on your driver's license:

If yes, list all restrictions:

Has your license ever been suspended or revoked:

If yes, please explain:

State all of your motor vehicle violations including but not limited to: Speeding, reckless driving, driving under the influence, driving while impaired, or driving while suspended. For each violation state the County and State where the offense occurred and the year of:

Impairments / Physical Limitations

Do you have an impairment/physical limitation which would affect your ability to perform certain jobs:

If yes, please explain the type of jobs which may prove difficult:

For each job listed that may prove difficult for you to perform due to an impairment or physical limitation, are there reasonable accommodations that Area Five could make which would enable you to satisfactorily perform this work?

If so, please describe these accommodations:

Discharged / Asked To Resign

Have you ever been discharged or asked to resign from any position:

If yes, for each occasion that you were discharged or requested to resign, please state the name of the employer, the dates of employment and the reason(s) you were terminated or asked to resign:

To protect your privacy, this form will automatically timeout after you've made no changes for 2 hours.
Use the Application Lookup Tool to retrieve an uncompleted application that has timed out. Your information will be saved for 28 days after you start the application process.