5100 Lincoln St. • Denver, Colorado 80216
303-296-2400 • FAX: 303-296-4012 • TDD: 720-974-6821
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, citizenship, veteran status or any other characteristic protected by law. If you would like more information on your EEO rights under the law, please click here: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf.
As required by law, we must record certain information to be made a part of
our Affirmative Action Program.
Applicants for employment are also invited to participate in the
Affirmative Action Program by reporting their status as disabled, disabled
veteran, veteran of the Vietnam era or other minority. In extending this
invitation you are also advised that: (a) workers (applicants) are under no
obligation to respond, but may do so in the future if they choose; (b)
responses will remain confidential within the Human Resources Department;
and (c) responses will be used only for the necessary information to
include in our Affirmative Action Program. We are a company that values
diversity. We actively encourage women and minorities to apply. Refusal to
provide this information will have no bearing on your application and will
not subject you to any adverse treatment.
Please list most recent employer first. Account for all periods of
employment and unemployment.
MOST RECENT EMPLOYER
CITY, STATE, ZIP CODE
REASON FOR LEAVING
Please list work history that relates to the position you are currently
applying for. Do not use employers from above.
Include only professional references - individuals familiar with your work
ability. DO NOT INCLUDE FRIENDS OR RELATIVES. NOTE:
Job offer may be contingent upon acceptable references from current and
YEARS KNOWN AND RELATIONSHIP
Have you lived in Colorado for less than two years?
Have you ever been arrested or convicted of a crime?
I understand that any false information, omissions or misrepresentations of
facts called for in this application may result in rejection of my
application or discharge at any time during my employment. I authorize
Laradon and/or its agents to verify any of this information including, but
not limited to, motor vehicle driving records (if applicable) and criminal
history. I authorize all persons, schools, companies and law enforcement
authorities to release any information concerning my background and hereby
release any said person, schools, companies and law enforcement authorities
from any liability for any damage whatsoever for issuing this information.
I also understand that the use of drugs and/or alcohol is prohibited during
employment. I am willing to submit to drug/alcohol testing to detect the
use of illegal drugs/alcohol prior to and during employment. Any applicant
who knowingly or willfully makes a false statement of any material fact or
thing in the application is guilty of perjury in the second degree as
defined in Section 18-8-503, C.R.S., and, upon conviction thereof, shall be
punished accordingly. According to the Federal Fair Credit Reporting Act, I
am entitled to know if employment was denied based on information obtained
by my prospective employer, and to receive, upon written request, a
disclosure of the public record information and of the nature and scope of
the investigative report.
the policy of this organization to provide equal employment opportunity to
all qualified applicants for employment without regard to race, color,
religion, national origin, sex, age, veteran status or disability. As an
affirmative action employer under E.O. 11246, we invite all applicants to
identify themselves as indicated below.
Racial origin (You may mark one or more of the following):
White – A person having origins in
any of the original peoples of Europe, the Middle East, or North
American Indian or Alaska Native –
A person having origins in any of the original peoples of North and South
American (including Central America), and who maintains tribal affiliation
or community attachment.
Black or African American – A
person having origins in any of the black racial groups of
Asian – A person having origins in
any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China, India, Japan, Korea,
Malaysia, Pakistan, the Philippine Islands, Thailand, and
Native Hawaiian or Other Pacific Islander
– A person having origins in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific Islands.
Hispanic or Latino – A person of
Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish
culture or origin, regardless of race.
Sex:MaleFemaleI elect not to identify
is a federal contractor subject to the Vietnam Era Veterans’ Readjustment
Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38
U.S.C. 4212 (“VEVRAA”), which requires contractors to take affirmative
action to employ and advance in employment:
believe you belong to any of the categories of protected veterans listed
above, please indicate by checking the appropriate box below. As a
government contractor subject to VEVRAA, we request this information in
order to measure the effectiveness of the outreach and positive recruitment
efforts we undertake pursuant to VEVRAA. This information is being
requested on a voluntary basis and will be kept confidential, consistent
with applicable law. Refusal to provide the requested information will not
subject you to any adverse treatment. If provided, this information will
not be used in a manner inconsistent with VEVRAA.
I identify as one or more of the classifications of protected veteran listed above.I am not a protected veteran.I choose not to self-identify.
Because we do business with the government, we must reach out to, hire, and
provide equal opportunity to qualified people with
disabilities.1 To help us
measure how well we are doing, we are asking you tell us if you have a
disability or if you ever had a disability. Completing this form is
voluntary, but we hope that you will choose to fill it out. If you are
applying for a job, any answer you give will be kept private and will not
be used against you in any way.
already work for us, your answer will not be used against you in any way.
Because a person may become disabled at any time, we are required to ask
all of our employees to update their information every five years. You may
voluntarily self-identify as having a disability on this form without fear
of any punishment because you did not identify as having a disability
You are considered to have a disability if you have a physical or mental
impairment or medical condition that substantially limits a major life
activity, or if you have a history or record of such an impairment or
Disabilities include, but are not limited to:
Please check one of the boxes below:
Yes, I have a disability (or previously had a disability)No, I don’t have a disabilityI don’t wish to answer.
Federal law requires employers to provide reasonable accommodation to
qualified individuals with disabilities. Please tell us if you require a
reasonable accommodation to apply for a job or to perform your job.
Examples for reasonable accommodation include making a change to the
application process or work procedures, providing documents in an alternate
format, using a sign language interpreter, or using specialized
1Section 503 of the Rehabilitation Act of 1973, as amended. For more
information about this form or the equal employment obligations of Federal
contractors, visit the U.S. Department of Labor’s Office of Federal
Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
PUBLIC BURDEN STATEMENT According to the Paperwork Reduction Act of 1995,
no persons are required to respond to a collection of information unless
such collection displays a valid OMB control number. This survey should
take about 5 minutes to complete.