Veterans Green Jobs Employment Application

Date*

Position Applied For*

Contact Information

Last Name*

First Name*

Middle Initial*

Street Address / P.O. Box*

City*

State*

Postal Code*

Phone*

Please use the following format: (###)### - ####

I. Education and Training

Highest Level of Education*

Name and location of school*

Did you graduate?*

Yes
No

Years Completed*

Please enter a value between 1 and 10.

Degree / Certificate*

II. Skills (please check all the relate to the job you are applying for)

Office

Typing
10-key
Data base management
Personal Computer

Typing Words per Minute

List applications or software you are familiar with:

Vocational

If "Other", please describe

III. Military Experience

Have you ever served in the Armed Forces?*

Yes
No

Which branch of the Armed Forces?*

A copy of your DD214 discharge form will be required if you are hired.

Are you presently a member of the National Guard?*

Yes
No

National Guard Specialty

Date Entered

Anticipated Discharge Date

IV. Additional Background

Do you have a valid Colorado driver's license?*

Yes
No

Colorado Driver's License number*

Colorado Driver's License expiration date*

If you DO NOT have a Colorado Driver's License, do you have a valid out-of state-driver's license?*

Yes
No

Out-of state-driver's license number*

Out-of state-driver's license expiration date*

Out-of state-driver's license state of issue*

What type of license do you currently have?*

Operator
Commercial (CDL)
Chauffuer

Have you had any traffic accidents in the past 3 years?*

Yes
No

Have you had any moving violations in the past 3 years?*

Yes
No

Has your license ever been suspended or revoked?*

Yes
No

Please explain anything you answered "yes" on*

Are you at least 18 years old?

Yes
No

When will you turn 18?

MM

DD

YYYY

Have you ever been convicted of a crime?*

No
Yes

Please explain reason for conviction*

Explain conviction(s), nature of offense(s) leading to conviction(s), date(s) of conviction, sentence(s) imposed, and/or type(s) of rehabilitation.

V. Work History

1. Employer Name*

Address*

City*

State*

Supervisor*

Job Title*

Employment Start*

MM

DD

YYYY

Employment End*

MM

DD

YYYY

Job Duties*

Rate of Pay*

Reason for Leaving*

2. Employer Name*

Address*

City*

State*

Supervisor*

Job Title*

Employment Start*

MM

DD

YYYY

Employment End*

MM

DD

YYYY

Job Duties*

Rate of Pay*

Reason for Leaving*

3. Employer Name

Address

City

State

Supervisor

Job Title

Employment Start

MM

DD

YYYY

Employment End

MM

DD

YYYY

Job Duties

Rate of Pay

Reason for Leaving

4. Employer Name

Address

City

State

Supervisor

Job Title

Employment Start

MM

DD

YYYY

Employment End

MM

DD

YYYY

Job Duties

Rate of Pay

Reason for Leaving

Attach Resume (optional)

Please attach your resume as a Microsoft Word Document, Text file, or Adobe PDF document.

VI. Additional Job Skills, Volunteer Experience, Certifications, Training

Please provide any additional information you would like to share regarding other job skills, tools, equipment, language skills, training or volunteer experience you have that may relate to the job for which you are applying.

VETERANS: Please take this opportunity to describe any expertise, specialty training, education or other skills you obtained while in the military that may relate to the job for which you are applying.

Additional Information

Affidavit, Consent, and Release

Please read each statement carefully before signing

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration and may result in my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application including a criminal background check, if applicable. I also authorize, whether listed or not, any person, school, current employer, past employers and organization to provide relevant information and opinions that may be useful in making a hiring decision. I release such person and organizations from any legal liability in making such statements.

I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information that may be deemed necessary to judge my capability to do the work for which I am applying.

I understand that this application, verbal statements by management, or subsequent employment does not create an expressed or implied contract of employment for any definite period of time.

Check box to consent*

Yes, I represent the statements made in this application to be true to the best of my knowledge. By entering my name in the corresponding text area, I certify them as such and acknowledge that this represents my signature to that effect.

Type legal name as signature*

Date*

Veterans Green Jobs Employment Application