EMPLOYMENT

List names of employers in consecutive order with present or last employer listed first. Account for any gaps and any period of unemployment. If self-employed, give firm name and supply business referenced. PLEASE GIVE MONTH AND YEAR.

Applicants are considered for all positions and during employment all employees are treated without regard to race, color, religion, sex, national origin, ancestry, age, veteran status, disability, and any other legally protected status. As an employer we comply with government regulations, including affirmative action responsibilities where they apply. For the sole purpose of helping us comply with government record keeping, reporting, and other legal requirements, we request that you complete this data record. Thank you for your cooperation. This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment. YOUR COOPERATION IS VOLUNTARY.