Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accomodation?
Have you been convicted of any felonies other than minor traffic violations during the past seven years? (A criminal record or a conviction will not automatically bar employment, but will be considered only as it reasonably relates to perform in the position for which you are applying.)
If required, will you work? *
READ CAREFULLY: I certify that the information contained in this application is correct to the best of my knowledge and understand that my misstatement or omission of information may result in denial of employment or discharge. I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.