Ibis Tek LLC is an Equal Opportunity Employer. In extending this invitation you are also advised that: (a) 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. We are a company that values diversity. We actively encourage women and minorities to apply. 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. Thank you for your cooperation.

Section 1: General Applicant Information

Name	Date
Position Applied For                 *Position Title Must be From Website Listing, All Other Applications are Discarded

Section 2: Please check all that apply (See below for definitions)

Race or Ethnic Identity	Gender
Hispanic or Latino White (not Hispanic or Latino) Black or African American (not Hispanic or Latino) Native Hawaiian or Pacific Islander (not Hispanic or Latino) Asian (not Hispanic or Latino) American Indian or Alaskian Native (not Hispanic or Latino) Two or More Races (not Hispanic or Latino)	Male Female
Veteran Status
Vietnam Era Veteran Special Disabled Veteran Other Eligible Veteran Recently Separated Veteran

Hispanic or 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.

Ibis Tek is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, age, national origin, genetics, disability, veteran status, or any other classification protected by law. We participate in E-Verify.

APPLICANT INFORMATION
Last Name	First Name	M.I.	Date
Street Address			Apartment/Unit#
City		State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	ZIP
Phone		E-mail Address
Social Security No.		Date Available	Desired Salary
Position Applied For                 *Position Title Must be From Website Listing, All Other Applications are Discarded
Are you a citizen of the United States?         Yes No		If no, are you authorized to work in the U.S.?         Yes No
Have you ever worked for this company?         Yes No		If yes, when?
Have you ever been convicted of a felony?         Yes No		If yes, when?
Do you have a valid drivers license?         Yes No

EDUCATION
High School	Address
From     To	Did you Graduate? Yes No	Degree
College	Address
From     To	Did you Graduate? Yes No	Degree
Other	Address
From     To	Did you Graduate? Yes No	Degree

REFERENCES
Please list three professional references.
Full Name	Relationship
Company	Phone
Address
Full Name	Relationship
Company	Phone
Address
Full Name	Relationship
Company	Phone
Address

PREVIOUS EMPLOYMENT
Company		Phone
Address		Supervisor
Job Title	Starting Salary	Ending Salary
From     To	Reason for Leaving
May we contact your previous supervisor for a reference? Yes No
Company		Phone
Address		Supervisor
Job Title	Starting Salary	Ending Salary
From     To	Reason for Leaving
May we contact your previous supervisor for a reference? Yes No
Company		Phone
Address		Supervisor
Job Title	Starting Salary	Ending Salary
From     To	Reason for Leaving
May we contact your previous supervisor for a reference? Yes No

MILITARY SERVICE
Branch	Rank at Discharge	From     To
Type of Discharge	If other than honorable, explain

WHERE DID YOU HEAR ABOUT US?
Please tell us where you heard about Ibis Tek and this Position:

DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature (Type Name)	Date
I certify this to be true and correct.