Welcome to Sciolex Corporation’s Employment Application – Step 1 of 4Last Name *First Name *Middle Name If no Middle Name, please enter NMNAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTelephone Number *(111) 222 3333Telephone (Type)HomeCellWorkEmail Address *name@domain.comPosition Applying For *Employment Sought *No PreferenceFull-TimePart-TimeTemporarySeasonalLocation of PositionDesired Start Date *MM/DD/YYYYSalary ExpectationDo Not Include BenefitsCurrently Employed *UnemployedEmployed-HR May Contact My EmployerEmployed-HR Do NOT Contact My EmployerCan You Verify Legal Right to Work in the USA? *YesAt Least 18yrs or Older? *YesHow Did You Hear About Us? *Walk-InAdvertisement SourceReferralOtherSpecify your own value: *Specify your own value when Other is selected from the form field aboveHigh School *Enter the Name of HS AttendedHS Location *Enter the Street, City, St, Country, Zip for the HS AttendedHS Graduate *YesCollege 1College 1 LocationCollege 1 Graduate?YesCollege 1 MajorCollege 2College 2 LocationCollege 2 Graduate?YesCollege 2 MajorTrade/Business SchoolTrade/Business School LocationTrade/Business School Graduate?YesTrade/Business School MajorProfessional CertificationsEnter Professional CertificationCurrent ClearanceNoneSuitability-Low RiskSuitability-Moderate RiskSuitability-High RiskConfidentialSecretTop SecretTop Secret/SCIClearance Sponsor *N/ACIADHSDIADNIDoDFBINGANGONSAUSCGUSCISOther Clearance SponsorSpecify your own valueSpecify your own value:Specify your Other Clearance Sponsor hereBI or SSBI DatePolygraphCounter IntelligenceLife-StyleCI Poly DateLS Poly DateEnter SSNEmployment HistoryMost Recent Company 1 *Company NameCompany 1 Position *Enter your position titleCompany 1 Start Date *Company 1 End DateImmediate Supervisor *Enter Immediate Supervisor’s NameSupervisor's Email *Supervisor's Phone *(111) 222 3333May We Contact? *YesNoReference 1 Full NameReference 1 AssociationCo-WorkerSupervisorPersonal-Non RelativeReference 1 Yrs AcquaintedReference 1 Phone Number(111) 222 3333Reference 1 Email Addressname@domain.com Reference 2 Full NameReference 2 AssociationCo-WorkerSupervisorPersonal-Non RelativeReference 2 Yrs AcquaintedReference 2 Phone Number(111) 222 3333Reference 2 Email Addressname@domain.comReference 3 Full NameReference 3 AssociationCo-WorkerSupervisorPersonal-Non RelativeReference 3 Yrs AcquaintedReference 3 Phone Number(111) 222 3333Reference 3 Email Addressname@domain.comResume UploadClick Choose File to UploadResume AttachedI have attached a copy of my most recent resume to this form** Note ** If you have not yet attached your resume; do so now using the “Choose File” Button Item above this dialogue box.Statement of Accuracy *I certify understanding that neither the completion of this application, nor any other part of my consideration for employment, establishes any obligation for Sciolex Corporation, or any of its subcontractors, to hire me. I also understand that either Sciolex Corporation or I, may terminate employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Sciolex Corporation has the authority to make any assurance to the contrary.Attestation *I attest with my electronic signature below that I have given to Sciolex Corporation true and complete information on this application. No request information has been concealed. I authorize Sciolex Corporation to contact references provided for employment reference checks. If any information I have provided is untrue or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal, regardless of when or how it was discoveredEOE *Sciolex Corporation is an equal opportunity employer. Sciolex Corporation does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, gender, gender identity, sex, sexual orientation, marital status, physical or mental disability, military status, or any other protected class identified by local, state, or federal law.Current Date *Electronic Signature * *Enter Name as SignatureConfirmYesChecking this box constitutes a legal signature confirming that I acknowledge and agree to the above disclaimer.Next Acknowledgement *Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as a veteran of the Vietnam era or other minority. In extending this invitation you are also advised that: (a) release of this information is voluntary – applicants are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment. Please complete the information requested below.Gender *FemaleMaleI choose Not to self-identifyEthnic Identification *Hispanic or LatinoNon-Hispanic or LatinoI choose Not to self-identifyRace Identification *WhiteBlack or African AmericanNative Hawaiian or Other Pacific Islander AsianAmerican Indian or Alaska NativeTwo or More Races (Not Hispanic or Latino)I choose Not to self-identifyVeteran Status *I am a Protected VeteranI am not a Protected VeteranI am a Protected VeteranI choose Not to self-identifyCategories for Protected Veteran Status (this is for informational purposes only in order for you to determine if you are a protected veteran, there is no need to further identify the classifications to which you belong). Veteran of the Vietnam-Era (i) A person who served on active duty for a period of more than 180 days and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred in the Republic of Vietnam between February 28, 1961 and May 7, 1975, or between August 5, 1964 and May 7, 1975, in all other cases, or (ii) A person who was discharged or released from active duty for a service-connected disability of any part of such active duty was performed in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or between August 5, 1964 and May 7, 1975, in all other cases. Special Disabled Veteran (i) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or (ii) A veteran entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under the laws administered by the Department of Veterans’ Affairs for disability who is rated at 30 percent or more or who is rated at 10 or 20 percent in the case of a veteran who has been determined under Section 3106 of Title 38, U.S.C. to have a serious employment handicap or (iii) A person who was discharged or released from active duty because of a service-connected disability. Active Duty Wartime or Campaign Badge Veteran 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. Recently Separated Veteran 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. Armed Forces Service Medal Veteran Any 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 (61 FR 1209).NextFCRA AuthorizationAcknowledgementPursuant to the federal Fair Credit Reporting Act, I hereby authorize Sciolex Corporation and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment, or retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state, or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.FCRA AuthorizationAuthorizationI authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish Sciolex Corporation or its designated agents with any and all information in their possession regarding me in connection with an application of employment. I am authorizing that a photocopy of this authorization be accepted with the same authority as the original. I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer’s rights will be provided to me.FCRA Date *FCRA Electronic Signature *Enter Full NameFCRA ConfirmationConfirmedChecking this box constitutes a legal signature confirming that I acknowledge and agree to the above disclaimer.NextVoluntary Self-Identification of Disability * AcknowledgeWhy are you being asked to complete this form? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. How do I know if I have a disability? 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. Including But Not Limited To: Blindness, Deafness, Cancer, Diabetes, Epilepsy, Autism, Cerebral Palsy, HIV/AIDS, Schizophrenia, Muscular Dystrophy, Bipolar Disorder, Major Depression, Multiple Sclerosis (MS), Missing Limbs or Partially Missing Limbs, Post-Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder, Impairments requiring the use of a wheelchair, Intellectual Disability (Previously called Mental Retardation)Self-Identification of DisabilityYes, I have a Disability (or previously had a disability)No, I don’t have a DisabilityI don’t wish to answerReasonable 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.WebsiteSubmit