Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered. All information given will be available only to persons who have a “need to know” or as required by law. If you need assistance in filling out this application, under the Americans with Disabilities Act (ADA), we will make reasonable accommodations. Please call 208-785-2274 or e-mail email@example.com to schedule. Assistance is also available at the Idaho Department of Labor.
This application is current only for thirty (30) days, at the conclusion of which time, if you have not heard from us and still wish to be considered for employment, it will be necessary for you to fill out a new application. If an application is received with no indication as to what position you are applying for it will not be considered.
List your last three employers, beginning with your most recent job first.
Please list the names of three people that you are NOT related to and that you have known for at least ONE year.
This Employment Application is used to notify me that the nature and scope of an investigation, if one is conducted, could include such general identification information as residence verification, and, as applicable, information concerning my employment, education, general reputation, character, personal characteristics, and habits, and that such information may be developed through personal interviews with third parties such as family members, neighbors, friends, associates, former employers, educational institutions, custodians of official records or other sources. Only job-related information developed from such a report will be considered in evaluating my employment application or continued employment. I hereby authorize these persons, companies, organizations or corporations to answer all questions or release any information regarding the items listed in this paragraph. I hereby release them form any liability and hold them, harmless from any claimfor releasing any truthful information within their knowledge and/or records.
I authorize the Company to release to any person, firm, entity or organization with which I may seek employment in the future, any truthful information within its knowledge and/or records.
I understand that any job offer that may be extended to me will be contingent upon the successful completion of a drug and alcohol test and background check.
I certify that the answers given by me to the foregoing questions and during any interview are true and correct without consequential omissions, and understand that, if employed, omissions and/or false statements on this application or during any interviews may result in dismissal. I understand and acknowledge that, if hired, my employment is for no definite period and either the Employer or I may terminate our relationship at will at any time, without notice or any reason, and that this employment application does not constitute an employment contract. I have had an opportunity to have my questions about this statement’s content and intent answered and I understand its terms.
If you have a resume, cover letter, or other materials, feel free to upload those files here:
Voluntary Self-Identification of Disability
Why are you being asked to complete this form?
We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified
people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we
must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability
or have ever had one. People can become disabled, so we need to ask this question at least every five years.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who
makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you
want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance
Programs (OFCCP) website at www.dol.gov/ofccp
How do I know if I have a disability?
A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had
such a condition, you are a person with a disability. Disabilities include, but are not limited to:
Disabilities include, but are not limited to:
- Alcohol or other substance use disorder (not currently using drugs illegally)
- Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
- Blind or low vision
- Cancer (past or present)
- Cardiovascular or heart disease
- Celiac disease
- Cerebral palsy
- Deaf or serious difficulty hearing
- Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
- Epilepsy or other seizure disorder
- Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
- Intellectual or developmental disability
- Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
- Missing limbs or partially missing limbs
- Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
- Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
- Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
- Partial or complete paralysis (any cause)
- Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
- Short stature (dwarfism)
- Traumatic brain injury
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond
to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5
minutes to complete.
Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
* Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
Pre-Employment Background Screening Notification and Release Authorization
In connection with my application for employment (including contract or volunteer services) or application for tenancy with Premier Technology, Inc. at 1858 W. Bridge St. Blackfoot, ID 83221, I understand consumer reports will be requested by you (“Company”). These reports may include, as allowed by law, the following types of information, as applicable: names and dates of previous employers, reason for termination of employment, work experience, reasons for termination of tenancy, former landlords, education, accidents, licensure, credit, etc. I further understand that such reports may contain public record information such as, but not limited to: my driving record, judgments, bankruptcy proceedings, evictions, criminal records, etc., from federal, state, and other agencies that maintain such records.
In addition, investigative consumer reports (gathered from personal interviews, as applicable, with former employers or landlords, past or current neighbors and associates of mine, etc.) to gather information regarding my work or tenant performance, character, general reputation and personal characteristics, and mode of living (lifestyle) may be obtained.
I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company. If hired to procure such reports at any time during my employment, contract, or volunteer period. I authorize without reservation, any person, business or agency contacted by the consumer reporting agency to furnish the above mentioned information.
This authorization is conditioned upon the following representations of my rights:
As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (PTZ) Monday through Friday) to obtain all information in Agency’s file for my review. I may obtain such information as follows: 1) In person at the Agency’s offices, which address is listed above. I can have someone accompany me to the Agency’s offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency’s information with this third party; 2) By certified mail, if I have previously provided identification in a written request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me.
I understand that if I am applying for employment in New York, that I have the right to receive a copy of Article 23-A of the New York Correction Law.
I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5 th Ave, Ste. 2000, Seattle, Washington 98104-3188, (206) 464-7744.
Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
Equal Employment and Affirmative Action
It is the policy of Premier Technology, Inc. to comply with the concepts and practices of affirmative action. It is the intent of Premier and its related policies to ensure equal employment opportunity to all qualified employees.
Premier commits to provide employment opportunity to all qualified persons, and to continue to recruit, hire, train, promote, and compensate persons in all jobs without regard to race, color, religion, citizenship, gender, national origin, age, disability, current or future military status, or special disabled veteran in accordance with federal law, and without regard to any individual's status protected by applicable state or local law.
Therefore, to keep our affirmative action plan updated we request that all employees and applicants complete this form. This information is supplied voluntarily and is collected only for the exclusive use of updating our affirmative action plan and will be maintained in a confidential file.
Please indicate which of the following categories apply to you: (check all boxes that apply)