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Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense(s), seriousness, and nature of the violation(s), rehabilitation, and position applied for will be considered.

Include dates of employments (starting and ending); position(s) held; company name, address, city, state, and zip code; telephone number; supervisor and title; responsibilities and description of work; starting and ending salary; and reason(s) for leaving.

I certify that my answers are true and complete to the best of my knowledge. I authorize CSC to make such investigations and inquires of my personal, employment, education, financial, and other related matters as may be necessary for an employment decision.

I hereby release employers, schools, or individuals from all liability when responding to inquires in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) with my application may result in discharge.