• General Information

  • please give a real number, i.e. not "negotiable", etc
  • Driver's License Information

  • Education

  • Employment History

    List below all present and past employers over the past ten years, starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.
  • (please state if current)
  • (please state if current)
  • (please state if current)
  • References

    Please do not list family relatives. We recommend listing persons such as coworkers, teachers, etc., who have knowledge of your qualifications for the position for which you are applying. DSS does require that we personally speak with each of your references, so we recommend that you let your references know to expect a call from us.
  • Questions

  • Electronic Initials & Signature

    I certify that, to the best of my knowledge & belief, the information given truly represents my background & experience. I understand that if I have knowingly misrepresented or falsified any of the application information I may be disqualified for employment consideration or dismissed from employment. I authorize my current & former employers to give any information regarding my employment, together with any information regarding me whether or not it is on their records. I hereby release them from any damage whatsoever for issuing same. I also permit this employer to make a background investigation of me.
  • Place your initials for Yes
  • Place your initials for Yes
  • First and last name
  • This field is for validation purposes and should be left unchanged.