| PERSONAL INFORMATION: |
| Are you at least 18 years old? | Yes: No: |
| If no, can you submit a work permit if hired? | Yes: No:
|
If hired, can you present evidence of your U.S. Citizenship or proof of your legal
right to live and work in this country? | Yes: No:
|
Are you able to perform the essential functions of the job for which you are
applying, either with or without reasonable accommodation? | Yes: No:
|
| If no, describe the functions that cannot be performed: |
(NOTE: WE COMPLY WITH THE AMERICANS WITH DISABILITIES ACT AND CALIFORNIA’S FAIR EMPLOYMENT AND HOUSING ACT. WE CONSIDER REASONABLE ACCOMMODATION MEASURES THAT MAY BE NECESSARY FOR ELIGIBLE APPLICANTS/EMPLOYEES TO PERFORM ESSENTIAL FUNCTIONS. HIRE MAY BE SUBJECT TO PASSING A MEDICAL EXAMINATION, AND TO SKILL AND AGILITY TESTS.) |
Have you ever been convicted of a felony?
(Do not identify any felony conviction for which the record has been judicially ordered sealed,
expunged, or statutorily eradicated.) | Yes: No: |
If yes, please explain and also state nature of the crime(s), when and where convicted and disposition of the case:
|
| Have you ever been convicted of a misdemeanor? | Yes: No: |
(Do not answer “yes” if the conviction record has been judicially ordered sealed, expunged, or statutorily eradicated.
Do not answer “yes” if probation for the conviction was successfully completed or discharged and the case was judicially dismissed under Penal Code section 1203.4.
Do not answer “yes” if your conviction was for misdemeanor marijuana convictions and is more than 2 years old.)
If yes, please explain and also state nature of the crime(s), when and where convicted and disposition of the case:
(NOTE: NO APPLICANT WILL BE DENIED EMPLOYMENT SOLELY ON THE GROUNDS OF CONVICTION OF A CRIMINAL OFFENSE. THE NATURE OF THE OFFENSE, THE DATE OF THE OFFENSE, THE SURROUNDING CIRCUMSTANCES AND THE RELEVANCE OF THE OFFENSE TO THE POSITION(S) APPLIED FOR MAY, HOWEVER, BE CONSIDERED.) |
