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Application For Employment

INSTRUCTIONS: This application must be filled out completely and submitted to RSCVA - Human Resources Dept. P.O. Box 837 or 4001 S. Virginia St, Reno, NV 89502. Failure to provide complete information may eliminate you from consideration for employment. As an EQUAL OPPORTUNITY EMPLOYER, the RSCVA does not discriminate against applicants or employees because of their age, race, color, religion, national origin, sex, disability, veteran status or any other legally protected status.

All fields marked with * are required.

6 . References
7 . Work Experience
8 . Acknowledgement
9 . Drug Testing

The information we are requesting on this form will be used to conduct statistical analysis in accordance with applicable state and federal regulations. There is no penalty if you do not complete this form; however, if you do not wish to voluntarily complete the form, our human resources department staff will complete the form by determining your ethnic identity through visual observation or other means. This information will be kept in a separate and confidential file and will not be used to make any employment decisions. This information will be provided to agencies responsible for the enforcement of civil rights.

Gender: Male Female
Age: Under 40 40 and Over
Ethnicity: Caucasian
Asian/Pacific Islander
American Indian or Alaskan Native
I choose voluntarily not to complete this section.
Do you have a Physical or Mental Impairment which substantially limits one or more of your major life activities? Yes No
If yes, explain:
Are you a disabled veteran? Yes No
Are you a veteran of the Vietnam era? Yes No

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