Fillable Application For Employment printable pdf download

Name of Applicant ______________________

Arizona State Personnel System

APPLICATION FOR EMPLOYMENT

Completion of this form in no way constitutes an offer of employment. The information requested is

required to provide us with information necessary to consider you for the position for which you are

applying.

DATE OF APPLICATION _____________________________

PLEASE PRINT LEGIBLY OR TYPE ALL REQUESTED INFORMATION

Position for which you are applying _______________________________________________

___________________________________________________________________________________________________

Last Name

First Name

M.I.

__________________________________________________________________________________________

Street Address

City

State

Zip Code

_______________________________________________

_________________________

Contact Phone Number(s) (include area code)

Contact E-mail Address

_______________________________________________

_________________________

Alternate Phone Number(s) (include area code)

State Agency Applying To

CONDITIONS OF CONSIDERATION FOR EMPLOYMENT

All information contained on the application is subject to verification. If applicable, the State of Arizona may

conduct background checks including, but not limited to, work references, driving records, criminal conviction

records and educational attainment.

You may be subjected to a criminal background investigation for some positions. If applicable, your fingerprints

may be sent to state and federal law enforcement agencies (DPS and FBI). All offers of employment and

continued employment may be subject to a complete review of any criminal convictions you may have. Your

failure to make a full and accurate disclosure of any prior conviction(s), or to answer the questions fully and

accurately, may result in immediate termination from employment or the rejection of any pending application or

offer from the State of Arizona.

CRIMINAL BACKGROUND INFORMATION (ALL APPLICANTS)

ALL QUESTIONS MUST BE ANSWERED TRUTHFULLY AND COMPLETELY. “Crime” as used in this section

means any and all felonies, misdemeanors and serious driving offenses, including but not limited to driving while

under the influence of intoxicating liquor (“DUI”) or drugs, extreme DUI, reckless driving, aggressive driving,

racing/exhibition of speed, excessive (criminal) speed, leaving the scene of an accident, driving on a suspended,

revoked or refused license or any other driving offense that is a misdemeanor (i.e., possible penalty for conviction

includes imprisonment or jail time). “Crime” does not include minor (civil) traffic offenses. If you are not sure how

to answer these questions, please ask a member of the Human Resources Department for assistance.

“Convicted” means you have been found guilty of a crime by a court or jury, or have pleaded guilty or

nolo contendere (“no contest”) to a crime and have been sentenced for a crime, whether imprisoned,

incarcerated, placed on probation, fined or received a suspended sentence.

**NOTE: A criminal conviction(s) may or may not constitute an automatic disqualification for employment.

Have you ever been convicted of any crime? Answer by writing “Yes” or “No” _________

If you have answered “yes” to this question, please give the details of offense(s) for which convicted, date(s) of conviction(s),

jurisdiction(s) (court, city, county, state, federal, foreign or military), and disposition(s) on the attached supplemental sheet

marked “Criminal Conviction History Form”. Exclude tickets for minor traffic and parking violations.

ASPS/HRD-FA3.01 10/12

1 of 7

Application For Employment

Related Articles

Related forms

Related Categories