AN EQUAL OPPORTUNITY EMPLOYER
Have you ever been convicted of a crime, served a jail sentence or period of probation subject to a plea bargain agreement, a plea of nolo contendre, or
a court order of adjudication withheld? YES NO
If YES, explain.
IF YOU OMIT OR FALSIFY REQUESTED INFORMATION IN YOUR RESPONSE TO QUESTION 1, YOUR APPLICATION
MAY BE DISQUALIFIED FROM CONSIDERATION OR YOU MAY BE DISCHARGED, IF HIRED.
Applicant's Signature _________________________________ Date ______________________________________
REQUIRED SCREENING
QUESTION
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