Application For Employment Court Of Justice Page 4
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4References
Please list at least 3 references other than relatives and former supervisors.
1. _____________________________________________________________________________________________
Last Name
First Name
Email Address
Phone
_____________________________________________________________________________________________
Street/Rural Route /PO Box
Apt. Ste or Apt. Box #
City
State
Zip Code (zip last 4 digits)
2. _____________________________________________________________________________________________
Last Name
First Name
Email Address
Phone
_____________________________________________________________________________________________
Street/Rural Route /PO Box
Apt. Ste or Apt. Box #
City
State
Zip Code (zip last 4 digits)
3. _____________________________________________________________________________________________
Last Name
First Name
Email Address
Phone
_____________________________________________________________________________________________
Street/Rural Route /PO Box
Apt. Ste or Apt. Box #
City
State
Zip Code (zip last 4 digits)
Statistics
EQUAL EMPLOYMENT OPPORTUNITY (EEO)
Qualified applicants are considered for employment without regard to race, religion, sex, national origin, age, marital status,
sexual orientation, veteran status, disability, or other protected classification as defined by applicable law and regulation.
As the employer, we may be subject to certain governmental record keeping and reporting requirements for the administration
of civil rights laws and regulations. In order to comply with these laws, we invite applicants to voluntarily complete these
statistics. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment.
The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable
laws, executive orders, and regulations, including those that require the information to be summarized and reported to the
federal government for civil rights enforcement.
Race/Ethnicity
____White ____Black or African American ____Hispanic or Latino ____Asian ____American Indian or Alaskan Native
____Other ____Native Hawaiian or other Pacific Islander ____Two or more races
Gender
____Female ____Male
Date of Birth _________________
Highest Degree Obtained ______________
Are you a veteran of the United States Armed Forces? ____Yes
____No
Signature
I certify that the information given in this application is correct and complete to the best of my knowledge. I am aware that
should an investigation at any time show any falsification, I may not be considered for employment or, if employed, I may be
dismissed and disqualified from employment. I hereby authorize the Court of Justice to make all necessary investigations
concerning me, my future work, habits, character, or my action in any transaction. I authorize the Court of Justice to
receive my academic records or other material pertinent to my qualifications, and further authorize and request each former
employer (including COJ, if applicable), person given as a reference, educational institution, or organization (including
law enforcement agencies) to provide all (including COJ, if applicable) information that may be sought in connection with
this application. I certify that I can perform the essential functions of the position for which I am applying, with or without
reasonable accommodations. I certify that I am the person that is listed in name on this application.
_________________________________________________________________________________________________
Applicant Signature
Date
Where did you hear about us? (please check one) [ ] Friend [ ] Job Fair [ ] Newspaper [ ] Web Search [ ] University
[ ] Link [ ] Other__________________________________________________________________________________
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