1. The Judicial Branch, State of Vermont is an Equal Opportunity Employer. Discrimination because of
age, sex, race, color, creed, national origin, disabling condition, gender identity, sexual orientation,
and religion. Any applicant for Judicial Branch employment who feels discriminated against in his
or her opportunity for employment may appeal, in writing, to the Court Administrator, no later than
five (5) calendar days from the effective date of the action being appealed.
2. Before being hired you must provide proof of U.S. citizenship or documentation that you are
authorized to work in the United States as required by the Immigration and Control Act of 1986.
3. I understand that the Judiciary may inquire about my criminal record history either during an
interview or once it determines that I am otherwise qualified for the positions. I understand
that if my criminal record history shows any convictions, I will have the opportunity to explain
the information and the circumstances regarding any convictions, including postconviction
rehabilitation. 21 VSA 495j (c )
I hereby certify that my application form and all attachments to it contain no false information and are
complete to the best of my knowledge. I authorize the Court Administrator’s Office Human Resources
Department to make any investigation of my personal history academic/professional credentials, military
service, criminal, and driving records through any investigative bureau of their choice. I am aware that if
an investigation discloses misrepresentation or falsification, my application may be rejected, my name
may be removed from the register and if already employed, I may be dismissed from State service, and I
may be disqualified from applying in the future for any position covered by the Rules and Regulations of the
State of Vermont. Applicant signature is required to be eligible for consideration.
Signature or typed name Date