REVIEW BEFORE SIGNING
I CERTIFY that the information I have given is complete, true, and correct to the best of my
knowledge. I further affirm that I have not knowingly withheld any facts or circumstances in
completing this application.
I UNDERSTAND that any incorrect, incomplete or false statements or information furnished by
me may void this application, remove me from consideration for employment, disqualify me from
applying for any other position with the Iowa Judicial Branch and subject me to discipline up to
and including discharge.
I understand that information on this application and any documents submitted to the Iowa
Judicial Branch as part of the application process may, in compliance with Iowa Code Chapter
22, become public record and may be made available to the public upon request. Only
information deemed confidential in accordance with applicable statutes may be withheld from
I understand that this application is not a guarantee of employment. I also understand that if
offered a position with the Judicial Branch, I may be required to submit to a background check as
a condition of employment. I understand that unsatisfactory results or refusal to cooperate with
this pre-employment check will result in withdrawal of any employment offer or termination of
employment if already employed.
I understand that the Immigration and Control Act of 1986 (Public Law #99-603) requires that all
new employees must provide documents proving their U. S. citizenship or their authorized alien
work status to begin employment. I further understand that all job offers are conditional on the
production of satisfactory documentation, as required by this law.
Authorization and Release
I AUTHORIZE the Iowa Judicial Branch to contact my current and former employers and to
conduct any reasonable inquiry that may be necessary to verify the information I have provided
on this form or may provide in conjunction with seeking employment. I hereby authorize any
current and former employers to verify information I have provided and to discuss any work-
related information concerning me, including, but not limited to, my position, job duties, salary,
job performance, attendance history, disciplinary record and the circumstances surrounding my
departure. I further unqualifiedly release those supplying such information from any and all
claims or liability associated with such discussion or disclosure as provided in Iowa Code Section
If you submit your application electronically, your printed name or a digitized signature placed in
the signature line acts as a valid signature.
Signature of Applicant Date