List your last four (4) employers, assignments or volunteer activities, starting with most recent, including military experience. Explain any gaps in employment in comments section below.
Include explanation of any gaps in employment. If none, enter N/A (not applicable).
Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our agency. If none, enter N/A (not applicable).
List last (3) schools attended, starting with the last one. List number of years completed. List major and minor field of study (if applicable). Indicate degree or diploma earned, if any.
List three business/work references who are not related to you and are not previous supervisors.
If not applicable, list three school or personal references who are not related to you.
List Licenses and/or Certifications that may qualify you as being able to perform job-related functions in the position for which you are applying. If none, enter N/A (not applicable).
List special accomplishments, publications, awards. If none, enter N/A (not applicable).
(Exclude information which would reveal sex, race, national origin, age, ancestry, handicap or other protested status.)
List any additional information you would like us to consider. If none, enter N/A (not applicable).
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Employment Acknowledgement Waiver