APPLICANT AUTHORIZATION, CERTIFICATION & AGREEMENT: (Read carefully before signing)
The facts set forth above in my application are true and complete. I understand that if employed, omissions or false statements on this application shall be considered sufficient cause for dismissal.
If employed, I understand and agree that my employment can be terminated at will with or without cause at anytime by myself or Glasser and Glasser, P.L.C. I understand that no one has authority to enter into any contrary agreements concerning my employment unless such agreement is in writing and signed by the Management Committee.
I authorize Glasser and Glasser, P.L.C. to make a thorough investigation of my past employment and activities and I agree to cooperate in such investigation. I understand that Glasser and Glasser may request Department of Motor Vehicle driving record reports and/or investigative reports from investigative agencies. These reports may involve information concerning my character, general reputation, personal characteristics and mode of living.
I understand that this application will be considered active for no more than two months and that after that time it may be necessary to reapply in order to be considered for employment.
Employment offers will be made contingent upon satisfactory completion of reference checks, drug screening, and criminal background checks. Human Resources will order the background checks and drug screening through an employment screening agency.
I understand in connection with my application for employment, I understand consumer reports will be requested by Glasser and Glasser, P.LC. I hereby authorize procurement of consumer report(s) by Glasser and Glasser, P.L.C. If hired, this authorization shall remain on file and shall serve as ongoing authorization for Glasser and Glasser, P.L.C. to procure such reports at any time during my employment. I authorize without reservation, any person, business or agency contacted by the consumer reporting agency to furnish the above-mentioned information.
Signature:
Equal Employment Opportunity
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.
The Information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.
Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender
Male
Female
I choose not to disclose this information
Ethnicity
Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race)
Not Hispanic or Latino (if not Hispanic or Latino, please address race below)
I choose not to disclose this information
Race (do not respond if you selected "Hispanic or Latino" above)
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the black racial groups of Africa
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above five races
I choose not to disclose this information
Protected Veterans
The definitions of protected veterans are listed below. Use the boxes following the definitions to indicate whether you are a protected veteran
Disabled Veteran
A "disabled veteran" is one of the following:
Recently Separated Veteran
A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
Active Duty Wartime or Campaign Badge Veteran
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
Armed Forces Service Medal Veteran
An "armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
I am not a Protected Veteran
I choose not to disclose this information
Disability Status
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Yes I have a disability (or previously had one)
No I don't have a disability
