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5100 Lincoln St. • Denver, Colorado 80216

303-296-2400 • FAX: 303-296-4012 • TDD: 720-974-6821

Laradon.org


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.


EMPLOYMENT APPLICATION

Today’s Date:

Last Name:

First Name:

Middle Name:

Maiden Name:

Street Address:

City:

State:

Zip Code:

Best phone number to contact you:

E-Mail Address:




AVAILABILITY


For which position are you applying?

Date available for work?

Desired Salary?

Have you ever applied or worked here before?


Type of Employment Desired?


Can you work overtime if required?


How did you hear about us?






If Internet Site, which one?

If Laradon Employee, who?

If Other, please specify:

Are you related to anyone currently working for or enrolled at Laradon?


If Yes, who?

Relationship?



EXPERIENCE

Please list most recent employer first. Account for all periods of employment and unemployment.


MOST RECENT EMPLOYER

EMPLOYER

EMPLOYER

STREET ADDRESS

STREET ADDRESS

STREET ADDRESS

CITY, STATE, ZIP CODE

CITY, STATE, ZIP CODE

CITY, STATE, ZIP CODE

TELEPHONE NUMBER

TELEPHONE NUMBER

TELEPHONE NUMBER

SUPERVISOR’S NAME

SUPERVISOR’S NAME

SUPERVISOR’S NAME

SUPERVISOR’S PHONE

SUPERVISOR’S PHONE

SUPERVISOR’S PHONE

SUPERVISOR’S EMAIL

SUPERVISOR’S EMAIL

SUPERVISOR’S EMAIL

DATES EMPLOYED


START

END

SALARY/PAY RATE


START

END

DATES EMPLOYED


START

END

SALARY/PAY RATE


START

END

DATES EMPLOYED


START

END

SALARY/PAY RATE


START

END

POSITION/DUTIES

POSITION/DUTIES

POSITION/DUTIES

REASON FOR LEAVING

REASON FOR LEAVING

REASON FOR LEAVING

REFERENCE/PHONE/EMAIL

REFERENCE/PHONE/EMAIL

REFERENCE/PHONE/EMAIL

REFERENCE/PHONE/EMAIL

REFERENCE/PHONE/EMAIL

REFERENCE/PHONE/EMAIL



WORK HISTORY

Please list work history that relates to the position you are currently applying for. Do not use employers from above.


MOST RECENT EMPLOYER

EMPLOYER

EMPLOYER

STREET ADDRESS

STREET ADDRESS

STREET ADDRESS

CITY, STATE, ZIP CODE

CITY, STATE, ZIP CODE

CITY, STATE, ZIP CODE

TELEPHONE NUMBER

TELEPHONE NUMBER

TELEPHONE NUMBER

SUPERVISOR’S NAME

SUPERVISOR’S NAME

SUPERVISOR’S NAME

SUPERVISOR’S PHONE

SUPERVISOR’S PHONE

SUPERVISOR’S PHONE

SUPERVISOR’S EMAIL

SUPERVISOR’S EMAIL

SUPERVISOR’S EMAIL

DATES EMPLOYED


START

END

SALARY/PAY RATE


START

END

DATES EMPLOYED


START

END

SALARY/PAY RATE


START

END

DATES EMPLOYED


START

END

SALARY/PAY RATE


START

END

POSITION/DUTIES

POSITION/DUTIES

POSITION/DUTIES

REASON FOR LEAVING

REASON FOR LEAVING

REASON FOR LEAVING

REFERENCE/PHONE/EMAIL

REFERENCE/PHONE/EMAIL

REFERENCE/PHONE/EMAIL

REFERENCE/PHONE/EMAIL

REFERENCE/PHONE/EMAIL

REFERENCE/PHONE/EMAIL




OTHER PROFESSIONAL REFERENCES NOT LISTED 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 former employer.

NAME

COMPANY

PHONE

EMAIL

YEARS KNOWN AND RELATIONSHIP


Have you received any disciplinary actions at any previous employment?


If Yes, please describe:




EDUCATION

  NAME CITY/STATE GRADUATE DEGREE & MAJOR

HIGH SCHOOL

COLLEGE

OTHER




JOB-RELATED SKILLS

If your position requires that you drive, do you have a valid driver’s license?


State of issue:

DL#:

Type of driver’s license:

Please list any other skills, licenses or certificates that are job-related.




SECURITY

Have you lived in Colorado for less than two years?


If yes, in which states:

Other name(s) under which records may be listed

Have you ever been arrested or convicted of a crime?


If yes, please describe below:

INCIDENT DATE CITY/STATE CHARGE




ADDITIONAL INFORMATION


Use this space for any additional information you think would help us evaluate your application including training, seminars, workshops or specialized skills:




CERTIFICATION AND RELEASE

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.


APPLICANT AFFIRMATIVE ACTION INFORMATION


It is 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.


COMPLETION OF THIS FORM IS VOLUNTARY AND IN NO WAY AFFECTS THE DECISION REGARDING YOUR APPLICATION FOR EMPLOYMENT. THIS FORM IS CONFIDENTIAL AND WILL BE MAINTAINED SEPARATELY FROM YOUR APPLICATION FORM.



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 Africa.


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 Africa.


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 Vietnam.


Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.


Ethnicity:


Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.


Sex:


PRE-OFFER INVITATION TO APPLICANTS TO SELF IDENTIFY AS A PROTECTED VETERAN


Laradon 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:


  1. disabled veterans defined as (a) veterans of the U.S. military, ground, naval or air service who are entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or (b) person who were discharged or released from active duty because of service-connected disability;

  2. recently separated veterans defined as any veterans during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service;

  3. active duty wartime or campaign badge veterans defined as veterans who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense; and

  4. Armed Forces service medal veterans defined as veterans who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.


If you 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.





Voluntary Self-Identification of Disability

Why are you being asked to complete this form?


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.


If you 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 earlier.


How do I know if I have 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 medical condition.


Disabilities include, but are not limited to:



  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral palsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular dystrophy
  • Bipolar disorder
  • Major depression
  • Multiple sclerosis (MS)
  • Missing limbs or partially missing limbs
  • Post-traumatic 􏰀stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual disability (previously called mental retardation)


Please check one of the boxes below:




Reasonable Accommodation Notice


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 equipment.


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.



 I have read and understand Certification and Release: (Required)