HR USDA REAP Application Form

HR USDA REAP Application Form

Position Applied For:   Department:   Location Preference:

Personal Information

Primary Phone:   Email:

Date of Birth:   U.S. Citizenship Status: I am a U.S. citizen

Position Information

Employment Type Desired: Full-time Part-time Temporary/Seasonal

Willing to travel for USDA REAP duties: Yes No   Willing to relocate: Yes No

Employment History

Employer 1

Supervisor:   Phone:

Job Title:   Dates Employed From:   To:

Employer 2

Supervisor:   Phone:

Job Title:   Dates Employed From:   To:

Education

Professional References

Reference 1

Phone:   Email:

Reference 2

Phone:   Email:

Reference 3

Phone:   Email:

Legal Disclosures and Authorizations

At-Will Employment Acknowledgment: I understand that, if hired, my employment with the employer is at-will and may be terminated by either party at any time, with or without cause or notice, unless a written agreement signed by an authorized representative of the employer provides otherwise. I acknowledge that no representative of the employer has the authority to enter into any agreement contrary to this at-will relationship unless signed in writing.

Equal Employment Opportunity: The employer provides equal employment opportunity to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetic information, or any other protected characteristic. All employment decisions are made in accordance with applicable law and the employer's nondiscrimination policy.

Authorization to Verify and Conduct Background Checks: By signing below I authorize the employer, its agents, and representatives to investigate my background, including but not limited to employment history, education, professional credentials, motor vehicle record, credit history where job-related, and criminal history for purposes of evaluating my suitability for employment with respect to duties that may include handling of program funds or sensitive information under USDA REAP. I authorize all employers, educational institutions, law enforcement agencies, and other persons or organizations to release information to the employer. I release such parties from any liability for providing the information.

Drug Testing and Security Clearance: I understand that employment may be conditioned on successful completion of a drug screening and, where applicable, security clearance or background investigation required for work on USDA REAP projects. I consent to such testing and any required clearance procedures.

Applicant Certification: I certify that all information I have provided on this application and any attachments is true, complete, and correct to the best of my knowledge. I understand that falsification, omission, or misrepresentation of information may result in refusal of employment or, if employed, termination.

Background and Conviction Disclosure: Have you ever been convicted of a felony or misdemeanor that has not been expunged or sealed? Yes No If yes, provide details:

Authorization to Contact Prior Employers: I authorize the employer to contact any and all of my previous employers to verify information provided and to obtain performance records and other information relevant to my qualifications for the position applied for.

Voluntary Self-Identification (Optional)

Veteran Status: Veteran Non-veteran Decline to answer

Supplemental Information (Program-Specific)

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