How did you hear about this job?
[YES/NO] Are you legally authorized to work in the United States?
[YES/NO] Do you, or will you in the future, require sponsorship for employment Visa status (e.g., H-1B Visa Status, etc.) to work legally for the Company in the U.S.?
[YES/NO] Have you ever been convicted of a criminal offense, had adjudication of a crime withheld, or pled nolo contendere (no contest) to a crime, including but not limited to robbery, embezzlement, forgery, perjury, drugs, tax evasion or any criminal offense involving dishonesty or breach of trust? If yes, please state your age at the time of the offense, type of offense, remoteness of the offense and time, disposition of the offense and any rehabilitation. Conviction of a crime will not necessarily be a bar to employment. The above factors will be taken into account in determining the effect on suitability for employment.
[YES/NO] Have you ever been arrested for any crime which has not yet been adjudicated? If yes, please give details regarding this arrest. An arrest will not necessarily be a bar to employment. The above details will be taken into account in determining the effect on suitability for employment.
[YES/NO] Have you ever been a defendant in a civil action for an intentional tort (for example, assault, battery, conversion, defamation, fraud and trespass)? If yes, please indicate the type of action and the disposition of the case.
[YES/NO] Have you ever been discharged or requested to resign from a position? If yes, please explain.
[YES/NO] In any previous employment, have you ever been notified by any representative of management or human resources that you have been accused by a coworker, customer or vendor of sexual or any other form of unlawful harassment? If so, please explain fully, including the ultimate outcome of the matter.
[YES/NO] Do you have the ability to perform the essential functions of the job for which you are applying? If No, please explain and describe, if possible, how, with or without accommodation, you may otherwise be able to perform these functions. This will be taken into account in determining your suitability for employment.
[YES/NO] May we contact your employer?
[YES/NO] CONTINGENCIES: Any offer of employment with the Company is contingent upon satisfactory completion of a background check and drug test. Are you willing to submit to a drug test?