Application for Employment


*
*
*
*
*
*

Jobs Applied For



*
*
*
Yes
No
*
Yes
No

*
Yes
No

*
Yes
No


Record Of Education

*
*
*
*
*







Professional References



Employment History (Most Current)

Yes
No




Yes
No




Yes
No

The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion or national origin. Public Law 90-202 prohibits discrimination because of age. Gem State Developmental Center (GSDC) does not discriminate because of handicapping conditions. The laws of some states prohibit some or all of the above mentioned types of discrimination.

I authorize all listed references, schools. and employers to answer all questions or release any information regarding my employment or educational experiences with them. I release them from any liability and hold them harmless from any claim for releasing any information within their knowledge and/or records. I further authorize Gem State Development Center (GSDC) to release to any person, firm, or organization with whom I may seek employment, any truthful information concerning my work experience with GSDC. I release and hold GSDC harmless from any claim for releasing any truthful information within their knowledge and/or records.

A resume may be submitted along wtih your completed application and can remain on file with GSDC for one year for future employment opportunities.

If hired, your employment with GSDC will be "at will" and for an unspecified term. Employment "at will" means that the employee or GSDC has the right to terminate the employment at any time, with or without cause or advanced notice.

All of the information provided in this application and any interview with GSDC is true and correct. I understand that if employed, misrepresentation or omissions are grounds for immediate termination. I also agree to abide by GSDC's rules and regulations.

I have read the above statements, have had an opportunity to have my questions about its content and intent answered and understand its terms.


*
*

* Required
You will receive a "Thanks for submitting your application" message if your application was successfully submitted. If you don't see this message then please correct any errors and resubmit.