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THACCD 101A (revised 12/20)
Are you now or have you ever been employed by the Housing Authority of the City and County of Denver (DHA)? Yes No
Please explain. (Past DHA employment)
IMMIGRATION REFORM ACT: The Immigration Reform Act of 1986 requires both identity and eligibility for employment proof within three days of
employment. DHA does NOT hire or sponsor H-1 Visa holders. Upon offer of employment, are you able to provide proof that you are eligible to work in the
United States without sponsorship (NAFTA, Green Card, US Citizen, or Permanent Resident)? Yes No
Have you been fired or asked to resign from any job during the past five years? Yes No
Please explain. (Fired or asked to resign)
Have you ever been found guilty of ANY law violations other than parking tickets or juvenile offenses? Records do not cause automatic disqualification, but
are reviewed as related to job(s) applied for. Be honest. If you have any convictions, list them here. If you do not remember your record, contact the
appropriate law enforcement agency for this information. DHA is as interested in honest and accurate disclosure as in the record itself.
Please explain. (Law violations)
Have you ever served on active duty (excluding training as a reservist or guardsman) in the U.S. Military Service? Yes No
Are you currently a DHA resident or receiving Section 8 Housing assistance? Yes No
Please Specify:
Are you a Section 3 eligible applicant? Yes No
Please Specify:
Are you related to any employee of DHA? Yes No
Please give name and relationship:
Please list other names you have used:
Additional Information
VOLUNTEER EXPERIENCE: Volunteer activities and non-paid experiences related to position for which you are applying should be submitted on an additional
sheet.
EDUCATION: If you are selected for hire, a copy of your high school diploma or GED high school equivalent certificate will be required. Official transcripts of
education may be required for certain positions.
DRIVING RECORD: If the job you are applying for requires driving, a copy of your driving record will be required prior to hire. If your driving record is not
acceptable pursuant to DHA’s Personnel Policy, you may be disqualified for hire.
NOTIFICATION: Your application will be kept on file for six months. If you are selected for testing and interview, you will be notified as soon as possible.
KEEP US UP TO DATE: If your availability, address or phone number changes after you file this application, notify us immediately. Failure to do so may result in
non-delivery of mail or cause your name to be removed from the applicant list.
BACKGROUND INVESTIGATION: New employees are investigated carefully, including national and local criminal background checks. Be sure to list any crimes for
which you were found guilty within the last seven (7) years. Include any plea of guilty or nolo contendere. False statements or omissions may result in
disqualification or dismissal.
In connection with your application for employment, please be advised that we may conduct a reference check. As an applicant for employment with DHA, you
are a consumer with rights under the Fair Credit Reporting Act. For explanation purposes, a “consumer reporting agency” is a person or business which, for
monetary fees, dues, or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on consumers for
the purpose of furnishing consumer reports to others, such as DHA.
An “investigative consumer report” means a consumer report or portion thereof in which information on your character, general reputation, personal
characteristics, or mode of living is obtained through personal interviews with your neighbors, friends, or associates or with others with whom you are acquainted
or who may have knowledge concerning any such items of information.
In the event an investigative consumer report is prepared, you may request additional disclosures regarding the nature and scope of the investigation requested
as well as a written summary of your rights under the Fair Credit Reporting Act.
YES NO