Fillable Arizona State Personnel System APPLICATION FOR EMPLOYMENT (PART (Arizona Department of Real Estate)

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Arizona State Personnel System APPLICATION FOR EMPLOYMENT (PART (Arizona Department of Real Estate)

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Arizona State Personnel System
APPLICATION FOR EMPLOYMENT (PART 1 OF 2)
Date of
Application
Completion of this application form in no way constitutes an offer of employment. The information is required to provide the agency with information
necessary to consider you for the position for which you are applying. All information contained on this application is subject to verification. If applicable,
the State of Arizona may conduct background checks, including, but not limited to, work references, driving records, and education attainment. If criminal
record information is not required prior to or at the time of the initial interview, it may be requested later in
the recruitment process. A criminal conviction(s) may or may not constitute an automatic disqualification from employment.
PLEASE PRINT LEGIBLY OR TYPE ALL REQUESTED INFORMATION
Job
Title
Last Name First Name
M.I.
City
State
ZIP Code
Cell
Personal E-mail
Address
Other
State
Agency
Page 1 of 5
Can you provide verification of your eligibility to work in the U.S.?
Will you now or in the future require sponsorship for employment visa status (e.g. H-1B visa status)?
Are you 18 years of age or older?
Do you currently or have you ever worked for the State of Arizona?
Applicant Name
(Last, First, MI)
Job ID #
Street
Address
Phone Numbers
(include area
codes)
If yes,
EIN
State
Agency
Last employment date
Yes
No
List reason for leaving
State employment
Have you ever been dismissed or allowed to resign from a position in lieu of dismissal?
If yes, provide the name of the employer, the
dates of employment, and describe the
circumstances, even if you do not agree with
your employer's decision. (If more space is
needed, use the "Additional Information" Section
on page 4.)
ASPS/HRD FA3.01 (1) 02/18
Yes No
Yes No
Yes No
Yes
No
State of Arizona Position for Which You Are Applying:
EMPLOYMENT HISTORY
Applicant Name
(Last, First, MI)
The State’s policy is to verify the most recent five (5) years of employment history by contacting current and prior
employers. If we cannot contact a specific employer, please explain the reason in the space(s) provided. Account for
all time, including self-employment, gaps in employment, or periods of unemployment. If you need additional space,
use the block on page 4.
Please list any other names you have
used while employed
To
(Mo/Yr)
From
(Mo/Yr)
DATES OF
EMPLOYMENT
Reason for
Leaving
Company
Phone #
Supervisor's
Name
Duties
Position
Ending
Salary
Starting
Salary
Company Name
Per Week, Month, Year
May we contact this employer?
Hours
per week
ZIP CodeState
City
Street
Address
Page 2 of
5
ASPS/HRD FA3.01 (1) 02/18
To
(Mo/Yr)
From
(Mo/Yr)
DATES OF
EMPLOYMENT
Reason for
Leaving
Company
Phone #
Supervisor's
Name
Duties
Position
Ending
Salary
Starting
Salary
Company
Name
Per Week, Month, Year
Hours
per week
ZIP Code
State
City
Street
Address
If "No",
please explain
May we contact this employer?
If "No",
please explain
Yes
No
Yes No
EMPLOYMENT HISTORY (continued)
Applicant Name
(Last, First, MI)
To
(Mo/Yr)
From
(Mo/Yr)
DATES OF
EMPLOYMENT
Reason for
Leaving
Company
Phone #
Supervisor's
Name
Duties
Position
Ending
Salary
Starting
Salary
Company
Name
Per Week, Month, Year
Hours
per week
ZIP CodeState
City
Street
Address
EDUCATION AND TRAINING
(Proof of your degree, license, professional registration or certification may be required upon hire)
College, University, Trade or Business
School(s)
City/State
(List campus attended)
Degree/Diploma
Year Attained
Hours
Earned
Major Area of Study
CURRENT LICENSES, PROFESSIONAL REGISTRATIONS/CERTIFICATIONS
Name of license, certification, or professional
registration
Accreditation/Institution
State Received
Year Attained Expiration Date
OTHER TRAINING/COURSE WORK
Type/Topic of Training
Accreditation/Institution
State Received
Level/Year Attained Diploma/Certificate
Page 3 of 5
ASPS/HRD FA3.01 (1) 02/18
May we contact this employer?
Yes
No
If "No" please explain
PROFESSIONAL REFERENCES
Required for applicants with no prior work history
Applicant Name
(Last, First, MI)
This page must be completed if you do not have employment history. Please list the names and contact information of
professional references (current and/or former teachers, professors, volunteer coordinators, internship managers, etc.)
who may be contacted.
Name Professional Relationship E-mail Address
From - To
(Mo/Yr)
Phone Number
ADDITIONAL INFORMATION
Please use the remainder of this page for any additional information.
Page 4 of 5
ASPS/HRD FA3.01 (1) 02/18
Page 5 of 5
ASPS/HRD FA3.01 (1) 02/18
STATE OF ARIZONA
DRIVER FORM
Applicant Name
(Last, First, MI)
Please complete this page if the position you are applying will require you to drive a vehicle as part of your job
responsibilities.
I understand to
operate a personally owned vehicle or fleet motor vehicle for the furtherance of State business purposes, I must
have an acceptable driving record and complete applicable driver training as required by Arizona Administrative Code
R2-10-207(12).
I understand the Driver Protection Privacy Act of 1994, amended September 1997, prohibits the release of my Motor Vehicle
Record for reasons other than matters of motor vehicle or driver safety.
I understand I may be asked and would be responsible for providing a copy of my thirty-nine (39) month motor vehicle record
history if I do not have a current Arizona driver license.
Name (print as it appears on your driver license)
State of Issue
Driver License Number
Do you have a current
valid U.S. driver license?
Do you have a current
valid U.S. commercial
driver license?
State of Issue Driver License Number
CERTIFICATION AND AGREEMENT
I certify that all the information provided in this application and in support of this selection process (i.e., resume) herein is true and
complete to the best of my knowledge. I agree and understand that omissions, misstatements and falsifications may cause
forfeiture on my part of all eligibility to any employment with the State of Arizona and may be cause for rejection of this
application, removal of my name from eligibility lists, or dismissal from State employment. In addition, I give the State of Arizona
the right to investigate and verify any information obtained through the application process. Permission is granted and I release
from any and all liability any employer, agency, individual or educational institution assisting the State of Arizona in providing
relevant, job-related information that will assist in the process.
My signature below certifies that I have read and understand this application and agree to the terms and conditions
outlined in the document.
Printed
Name
Date
Applicant
Signature
Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.
Persons with a disability may request a reasonable accommodation by contacting the agency Human Resources
Office. Requests should be made as early as possible to allow time to arrange the accommodation.
Yes
No
Yes
No
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Arizona State Personnel System APPLICATION FOR EMPLOYMENT (PART (Arizona Department of Real Estate)

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Completed 12 August 2020

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