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NOTICE: During the Background Check, we will
be contacting your present employer.
(For example: maiden name, former name(s), alias (es), or nickname(s).
(Trade, Vocational, Business or Military)
List in chronologically all employment beginning with present employment, including summer and part-time employment while attending school. All time must be accounted for. If unemployed for a period, set forth dates of unemployment.
Include Agency Name, Name of Complainant, Approximate Date and Disposition.
Include Agency Name, Name of Plaintiff(s), Approximate Date and Court Where Filed.
Include Agency Name, Supervisor/Administrator Taking Action, Approximate Date and Basis and Form of Discipline.
Include Agency Name, Basis for Exam, Approximate Date and Outcome.
Per Idaho Code, Title 65, Chapter 5, Employer will afford a preference to employment of veterans. In the event of equal qualifications and experience between candidates for an available position, a veteran who qualifies will be preferred. If claiming veteran’s preference, please complete the information below and attach a copy of your DD-214 to this application.(Reference Idaho Code, Title 65, Chapter 5, and 5 U.S.C. § 2108)The term “active duty” means full-time duty in the Armed Forces, but notactive duty for training.
Persons not related to you by blood or marriage.
List references who have known you well for at least five (5) years and who are not related to you by blood or marriage.
When requested by this agency, applicant will be fingerprinted and shall be required to submit to a drug test and complete physical examination, as well as be required to complete the Background Information form and a polygraph examination.
I hereby certify that each and every statement made on this form is true and complete to the best of my knowledge, and I understand that any misstatement or omissions of information will subject me to disqualification or dismissal. I, also, acknowledge that I have a continuing duty to update all information contained in this document and, if employed by this Agency, I acknowledge that my failure to update this information may result in my discipline up to and including termination from employment. I understand that should an investigation disclose inaccurate, incomplete or misleading answers, my application may be rejected and my name removed from consideration for employment with Employer, and if employed, my termination from employment.
Please print and bring in for notary completion.
This field is not part of the form submission.
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