![](https://var.fill.io/uploads/pdfs/html/1d978e77-2714-47c7-8ecc-bd5188e9e260/bg3.png)
IV. REFERENCES: It is the applicant's responsibility to provide New Horizons with at least three (3) work
references. One must be your current employer, if employed, and at least one (1) past employer.
Please list below the names of at least two (2) personal references.
X. OTHER INFORMATION
A. To avoid conflict of interest, list any relatives who serve on the Board of Trustees or relatives employed by New
Horizons and site relationship._________________________________________________________
B. Please provide any additional information you desire that will afford an additional understanding of your
qualifications. Your goals, objectives, philosophy, and other background factors are of special interest.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
By choosing "Accept" from the agreement box below, I authorize New Horizons Regional Education Centers to conduct a
background investigation and also authorize release of information in connection with my application for employment. This
investigation may include such information as criminal or civil convictions, driving records, if applicable, previous employers
and educational institutions, personal references, professional references, and other appropriate sources. I waive my right of
access to any such information, and without limitation hereby release to New Horizons and the reference source from any
liability in connection with its release or use. This release includes the sources cited above and specific examples as follows:
the local Sheriff, information from the Central Criminal Records Exchange of either data on all criminal convictions or
certification that no data on criminal convictions are maintained, information from the Virginia or other State Department of
Social Services Child Protective Services Unit and any Locality to which they may refer for release of information pertaining
to any findings of child abuse or neglect investigations involving me.
Furthermore, I certify that I have made true, correct and complete answers and statements on this application in the knowledge
that they may be relied upon in considering my application, and I understand that any omission, falsely answered statement
made by me on this application, or any supplement to it will be sufficient grounds for failure to employ or for my discharge
should I become employed with New Horizons. I am aware that fingerprinting is a part of the application process.
I agree with all the above terms and conditions. Accept
NEW HORIZONS REGIONAL EDUCATION CENTER IS AN EQUAL OPPORTUNITY EMPLOYER
In compliance with Executive Order 11246; Title II of the Education Amendments of 1976; Title VI of the Civil Rights Act of 1964, as
amended by the Equal Employment Opportunity Act of 1972; Title IX Regulation Implementing Education Amendments of 1972, Section
504 of the Rehabilitation Act of 1973; and all other federal, state, school rules, laws, regulations, and policies, New Horizons Regional
Education Centers shall not discriminate on the basis of sex, age, race, color, national origin, religion or disability in its education programs
and activities which it operates nor provisions of employment and services. Any complaints of alleged discrimination under Title IX (sex)
and Section 504 (disability) should be referred to: Human Resources Department, 520 Butler Farm Road, Hampton, VA 23666, (757) 766-
1100, ext. 3377.
HR-2 Revised 09/2015 3