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Employment Application
Contact Information
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First Name
Last Name



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*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Please check all that apply

Position Requirements
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Applicant Background

Answering yes to the question above does not automatically disqualify you for consideration for this position.


include conviction month/year in all responses
Work History


Please list your last 3 employers
starting with the most current


First Name
Last Name

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

(mm/dd/yyyy)

(mm/dd/yyyy)
Responsibilities / Job duties #1



First Name
Last Name

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

(mm/dd/yyyy)

(mm/dd/yyyy)
Responsibilities / Job duties #2



First Name
Last Name

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

(mm/dd/yyyy)

(mm/dd/yyyy)
Responsibilities / Job duties #3
Please check all that apply

(mm/dd/yyyy)

Please list major/field

(mm/dd/yyyy)

Please list major/field

(mm/dd/yyyy)

Please list major/field

(mm/dd/yyyy)

Please list major/field

(mm/dd/yyyy)

Please list major/field

(mm/dd/yyyy)


References
Please provide at least 1 personal reference and 2 professional references
Personal Reference

First Name
Last Name



Professional Reference #1

First Name
Last Name




Professional Reference #2

First Name
Last Name




Files to be uploaded
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Equal Opportunity / Affirmative Action / Civil Rights Policies and Procedures

It is the policy of I.M.P.A.C.T, INC to seek, emply, assign and promote the best qualified personnel in all of its operations, and to provide an equal opportunity for the advancement of employees, including trianing, upgrading and promotion, all in a manner which will not discriminate against any person on the basis of age, race, ethnicity, gender, creed, color, national origin, sexual orientatin, religion, marital status, or physical and / or mental disability. Applications for employment will be accorded equal treatment with respect to all terms, conditions, and privileges of employment, including recruitment, selection, placement, training and opportunities for advancement. In addition I.M.P.A.C.T, INC recognizes the need to reach out and assist individuals who might not otherwise be reached by our organization for employment opportunities.

It is not the policy of I.M.P.A.C.T, INC to promote preferential treatment, reverse discrimination, or quotas, but rather to implement remedial affirmation action to correct any staffing pattern which shows and underutilization of persons listed above and to prevent further employment discrimination of such persons. This policy applies to all levels of employment, and shall be considered an integral part of the personnel policy of the organization.

It is the intent of I.M.P.A.C.T, INC to comply with the spirit and the letter of state and federal constitution mandate, civil rights, regulations of various departments and executive orders of the Governor of the State of Nevada and the President of the United States of America.

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By submitting this form you acknowledge that as part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references.
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This will be your application signature