PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND INDICATE YOUR UNDERSTANDING AND ACCEPTANCE BY SIGNING IN THE THE SPACE PROVIDED BELOW:
1. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and release all such parties from all liability from any damages which may result from furnishing such information to you.
2. I understand that, if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.
3. I agree, if offered the position, to conform to all existing and future Company rules and regulations, and I understand that if hired, my employment will be at-will, meaning that either part can end the employment relationship at any time and for any reason.
4. I understand that this is a drug free workplace and consent to compliance with this policy as a condition of employment. I understand that any perceived or actual violation could be ground for termination.
5. I certify that this information contains no willful misrepresentation or falsification and that the information given by me is true and complete to the best of my knowledge and belief. I understand that if employed, misleading or falsified statements on this application may be considered cause for dismissal.
6. I understand that the employer will check with the Nebraska State Patrol and Nebraska Department of Health and Human Services or other organizations for any criminal history in accordance with applicable statutes.
7. I understand the the Employer does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age or any other characteristic protected by law
I have read and reviewed the information provided in this application and the above statements. By signing my name below, I certify that I fully understand the statements and have answered all questions completely and fully.
Equal Employment Opportunity
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.
The Information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.
Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender
Male
Female
I choose not to disclose this information
Ethnicity
Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race)
Not Hispanic or Latino (if not Hispanic or Latino, please address race below)
I choose not to disclose this information
Race (do not respond if you selected "Hispanic or Latino" above)
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
Asian (Not Hispanic or Latino)
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
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the black racial groups of Africa
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above five races
I choose not to disclose this information
Protected Veterans
The definitions of protected veterans are listed below. Use the boxes following the definitions to indicate whether you are a protected veteran
Disabled Veteran
A "disabled veteran" is one of the following:
Recently Separated Veteran
A "recently separated veteran" means any veteran 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.
Active Duty Wartime or Campaign Badge Veteran
An "active duty wartime or campaign badge veteran" means a veteran 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.
Armed Forces Service Medal Veteran
An "armed forces service medal veteran" means a veteran 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.
I am not a Protected Veteran
I choose not to disclose this information
Disability Status
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.
Yes I have a disability (or previously had one)
No I don't have a disability
