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ONLINE EMPLOYMENT APPLICATION
PERSONAL DATA
In order to prevent delay in the review of your application, answer every question on the form clearly and completely. (Indicate not applicable (N/A) where appropriate). All statements are subject to verification. DISC will not discriminate against any employee or applicant for employment because of race, color, religion, sex, age, national origin, or handicap, or due to the fact that he or she is a disabled veteran or a veteran of the Vietnam Era.

The field descriptions in BLUE text are required.
First Name: Last Name:
Address:
City: State:
Zip: Phone:
E-mail:
Desired Position:
If Other:
 
Attach resume:
ACCEPTABLE FORMATS: .doc, .wpd, .txt, .wks, .pdf
 
Employment History
Please list chronologically, beginning with most recent experience.
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Supervisor: Phone:
Salary:
Type of Work:
Reason for Leaving:
 
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Supervisor: Phone:
Salary:
Type of Work:
Reason for Leaving:
 
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Supervisor: Phone:
Salary:
Type of Work:
Reason for Leaving:
 
Education
Name & Location of School Select Last Year Completed Major Course Diploma/Degree
High School
College/University
College/University
Business or Trade School
 
Personal Information
.
Are you legally authorized to work in the U.S.?:
(If hired, you will be required to provide proof of work authorization.) 		Yes No
Are you at least 18 years of age?: Yes No
Briefly describe skills you may have that you acquired in other employment or armed forces:
Do you have any other skills you wish to mention?:
Are you presently employed?: Yes No
If so, may we contact your present employer?: Yes No
If hired, when would you be available?:
 
Employment References
List professional references below.
1) Name of Reference: 2) Name of Reference:
Occupation: Occupation:
Address: Address:
City/State/Zip: City/State/Zip:
Phone: Phone:
Relationship: Relationship:
How long known: How long known:


3) Name of Reference:    
Occupation:    
Address:    
City/State/Zip:    
Phone:    
Relationship:    
How long known:    
 

VOLUNTARY SURVEY
Government agencies require periodic reports on the sex and ethnicity.  This data is for analysis and possible affirmative action only.  SUBMISSION OF INFORMATION IS VOLUNTARY.
Gender: Male Female
Indicate The Appropriate Race/Ethnic Group:
The employer is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations.

In order to comply with these laws, the employer invites employees to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment.

The information obtained will be kept confidential and may only be used in accordance with the provision of applicable laws, executive orders and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement.

When reported, data will not identify any specific individual.  
How Were You Referred To This Job:
 
Please read carefully before submitting your application
AGREEMENT
Please read the following statements carefully, then type your name and date below and submit your form..
  • I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge and agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a late date.
  • I understand that neither this document nor any offer of employment from the employer constitutes an employment contract unless a specific document to that effect is executed by the employer and employee in writing.
  • I understand, if hired, I am employed at the will of the company.  Employment with DISC is not for a specific term and it can be terminated, by either the employer or DISC, with or without cause and with or without notice, at any time.
  • Employment is contingent upon proof of employment eligibility under immigration regulations.
  • As an applicant, I understand that this application for employment will be considered active for 90 days.
  • I authorize persons, schools, current employer (if applicable) and previous employers and organizations named in this application (and attached resume, if any) to provide DISC with any relevant information that may be required to arrive at an employment decision and release the above mentioned sources from liability in the information they may provide.
  • If employed by DISC, I agree not to divulge any confidential information obtained through employment with DISC.  Additionally, DISC is also assigned the absolute right, title, and interest of inventions or ideas, including computer programs developed while in DISC’s employ.  I consent to any and all photographic portraits or pictures of me taken in conjunction with my employment or at company functions.  I waive any right to inspect or approve any finished photographic work used by DISC.  I further agree not to engage in unfair competition of any sort with DISC, nor to disclose or use at any time either during subsequent to my employment, without DISC’s written permission, DISC proprietary or private data, confidential information, trade secrets or other materials or information in which the law recognizes as protectable interests.
  • If a United States Government security clearance is required after employment, I shall make application for same.  I understand that if I do not, that termination of my employment may result.
  • I understand that as an employee of DISC my title and/or job duties may change during the course of my employment.
Type your first and last name and today's date to certify that you have read and accept the above statements.
 
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