Marshalltown, IA – Application

Application for Employment

Employment History

Please provide information on your most recent employer. If you have no employment history, simply enter “not applicable”.

Second Most Recent Employer (NOTE: If you do not have any other employers to list, you may skip this page.)

Candidate Screening

Please answer the following screening information:

Voluntary Information

TLC Associates is a government contractor and to comply with the regulations for equal employment opportunity and affirmative action (EEO/AA), we must track our applicants by gender and race/ethnicity and the position they applied for to the government. We are an organization that values diversity and encourages women and minorities to apply. For this reason, we invite you to indicate your gender and race/ethnicity below. This information is kept separate from your application.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. Responses will remain confidential within the Human Resources Department; and will be used only for the necessary information to include in our Affirmative Action Program and reporting requirements to the government. When reported, data will not identify any specific individuals.

Definitions of race/ethnicity are on the next page (as defined by the Equal Employment Opportunity Commission)

Race/Ethnic Identification (check one)

If you answered “Yes” you have completed this form. If you answered “No” please select a race from the options below.

Definitions of race/ethnic categories

Hispanic of Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

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.

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.

Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above five races.

Sign and Date

IMPORTANT:PLEASE READ THE FOLLOWING AND SIGN/DATE

It is understood and agreed upon that any misrepresentation by me in the application or subsequent interview process will be sufficient cause for cancellation of this application and/or separation from the employer’s services if I have been employed. Furthermore, the electronic signature below authorizes the employer to conduct background checks related to any arrests or convictions that are a matter of public record. I give the employer the right to investigate all references and to secure additional job related information about me. I hereby release from any liability the employer and its representatives to seek such information and all other persons, corporations or organizations for furnishing such information.

TLC & Associates is an Equal Opportunity Employer, and as such does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on any basis prohibited by local, state, or federal law.

By indicating “yes” below, I acknowledge that I accept and agree to the terms of the employment statement above.