114 J Street, Old Sacramento, CA 95814
please read this application thoroughly and complete it honestly. This Employer performs a detailed background investigation on all final candidates.
Important Notice: Applicants should be extremely careful as they complete this application. Discover California utilizes a sophisticated and detailed background and pre-employment investigation process. This process frequently discloses inaccurate, false, and/or incomplete or omitted information. Should this process determine any inaccurate or incomplete information, it will cause you to be either disqualified for employment with this company as an applicant, or be grounds for termination if the inaccuracies are discovered subsequent to your employment with our firm. Accordingly, our company strongly suggests that you NOT complete this application until you have the requisite time and accurate information to do so.
This company is an equal opportunity employer and will not discriminate against any employee or applicant for employment in an unlawful manner. Employment is conditioned on the successful completion of the screening program. The information sought on this form is given voluntarily and may be used in filing reports required by state or federal governments. This company requires all individuals who are offered employment to submit to a drug and alcohol screening program, which may include blood and/or urine samples. The results of such screening will be initially disclosed to decision-makers for Discover California and may be the basis for disqualifying any candidate for employment. Our company reserves the right to utilize this information in any way it deems necessary, such as but not limited to, unemployment hearings, civil cases, criminal cases, and other such similar administrative hearings. By completing this application for employment, the applicant authorizes this employer to conduct such screening for drug and/or alcohol use, and agrees to hold this employer harmless for any claims resulting from such screening.
Applicant name: Date:
List other names you use or have used, including maiden names, nicknames, stage names, married names
Position(s) applied for or type of work desired:
Address:
Telephone #: Social Security #:
Type of employment desired: full-time part-time temporary
Date you will be available to start work:
Driver's License # ______________________ Salary Requirements ___________________/____
Are you able to meet the attendance requirements? Yes No
Do you have any objection to working overtime if necessary? Yes No
Can you work evenings and weekends? Yes No
Have you ever been previously employed by our organization? Yes No
If hired, can you show proof that you may legally work in the USA? Yes No
If you are under 18, can you furnish a work permit if it is required? Yes No
If yes, please explain (a conviction will not automatically bar employment):
Are you over 21 years of age? ______________________________
How were you referred to us?
Emergency Contact: ________________________________________/___________________________
Name Relationship
( )______________________
Home Phone Number Address
Work Phone Number/ext City State Zip
Employment History
Please provide all employment information for the past ten years employment starting with the most recent.
Employer: Position held:
Address: Telephone #:
Immediate supervisor and title:
Dates employed: from to Salary:
Job summary:
Reason for leaving:
Employer: Position held:
Address: Telephone #:
Immediate supervisor and title:
Dates employed: from to Salary:
Job summary:
Reason for leaving:
Employer: Position held:
Address: Telephone #:
Immediate supervisor and title:
Dates employed: from to Salary:
Job summary:
Reason for leaving:
Employer: Position held:
Address: Telephone #:
Immediate supervisor and title:
Dates employed: from to Salary:
Job summary:
Reason for leaving:
Other Skills and Qualifications
Summarize any job-related training, skills, licenses, certificates, and/or other qualifications:
Educational History
List school name and location, years completed, course of study, and any degrees earned:
High school:
College:
Technical Training:
Other:
References
List 3 people who can comment on your character and work habits, including telephone numbers, and years
known (do not include relatives or employers):
Except for the offense of possession of less than an ounce of marijuana for you personal use more than two years ago, have you ever been convicted of a crime? _______Yes _______No. If yes, please state the circumstances*._____________________________________________________________________________________________________________________________________________________________
Have you ever been convicted of the crime of possession of less than an ounce of marijuana for personal use within the past two years? ______Yes ________ No. If yes, please state the circumstances.* __________________________________________________________________________________________________________________________________________________________________________
Are you currently under arrest for any crime, other than the aforementioned crime of possession of less than one ounce of marijuana more than two years ago, which has yet to be adjudicated, pending trial?
______ Yes ______No. If yes, please state the circumstances.*
_____________________________________________________________________________________
Have you ever committed a crime? ________ Yes _______ No. If yes, please state the circumstances.*
*NOTE: Answering 'yes" to any of these questions may not necessarily disqualify you from the position desired. Each action and explanation will be weighted/considered in relationship to the position for which you are applying.
Please comment on why we should consider you for employment:
I hereby authorize Discover California to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability Discover California and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.
I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.
If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or Discover California can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.
I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the ADA.
I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.
I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.
Applicant signature: Date:
REQUEST, AUTHORIZATION, CONSENT AND RELEASE FOR BACKGROUND INFORMATION
(PLEASE TYPE OR PRINT)
I,
LAST NAME FIRST NAME MIDDLE NAME SUFFIX (Jr., Sr., II, etc.)
understand that in conjunction with my application for employment, DISCOVER CALIFORNIA! will use the services of an outside agency to research and verify the information I have provided on my application for employment including my personal background, character, professional standing, work history and qualifications. This agency will provide a report to DISCOVER CALIFORNIA! DISCOVER CALIFORNIA! uses Backgrounds Online, a consumer-reporting agency, as an agent to perform background verifications.
Backgrounds Online will utilize various sources of information it deems appropriate including but not limited to: credit reporting agencies, Workers Compensation records, Department of Motor Vehicle records, criminal conviction records, current and former employers, military records, education records, professional and personal references. I request, authorize and consent to the release and disclosure of any and all information including but not limited to the above to DISCOVER CALIFORNIA! and Backgrounds Online.
I request, authorize and consent to the procurement of an Investigative Consumer Report and understand that it may contain information about my background, mode of living, character, personal characteristics and general reputation. This authorization in original or copy form shall be valid for one year from the date indicated next to my signature. In accordance with the Fair Credit Reporting Act, DISCOVER CALIFORNIA! will notify me if employment is denied because of information obtained from a Consumer Reporting Agency. Additionally, I understand that if requested within 60 days, I will be given a full and accurate disclosure as to the nature and substance of all information provided to DISCOVER CALIFORNIA! I further understand that when requesting a copy of the report, proper identification will be required and I should direct my request to: Backgrounds Online, 1821 Q Street, Sacramento, CA 95814, phone: 800.838.4804.
LAW ENFORCEMENT AGENCIES AND OTHER ENTITIES FOR POSITIVE IDENTIFICATION PURPOSES REQUIRE THE FOLLOWING INFORMATION WHEN CHECKING PUBLIC RECORDS. IT IS CONFIDENTIAL AND WILL NOT BE USED FOR ANY OTHER PURPOSES. I HEREBY RELEASE DISCOVER CALIFORNIA! AND ITS AGENTS, BACKGROUNDS ONLINE AND ALL PERSONS, AGENCIES, AND ENTITIES PROVIDING INFORMATION OR REPORTS ABOUT ME FROM ANY AND ALL LIABILITY ARISING OUT OF THE REQUEST FOR OR RELEASE OF ANY OF THE ABOVE MENTIONED INFORMATION OR REPORTS.
Signed Today’s Date
Printed Name Position Applied For
__ - - _ _____/ __ /
Social Security Number Date of Birth Driver’s License Number State
Other names you have used or are also known as:
Current Address:
Street Apt.# City State Zip Code How long here?
Former Address:
Street Apt.# City State Zip Code How long here?
Former Address:
Street Apt.# City State Zip Code How long here?
May we contact your current employer? Yes No
Would you like a copy of this report? Yes No