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Consumer Report Authorization

In making this application for employment, it is understood that a copy of a consumer report prepared by a consumer reporting agency may be obtained. Information from the report will not be used in violation of any federal or state equal opportunity law or regulation. I acknowledge receipt of a separate disclosure that a consumer report may be obtained. I hereby authorize a copy of my consumer report from a consumer-reporting agency to be sent to stlb™.

Signature *

Clear Signature

Date *

Verification Authorization

I hereby authorize stlb™ to thoroughly investigate my background, any statement made on this application, references, employment record and other matters related to my suitability for employment. I authorize persons, schools, my current employer (if applicable), previous employers and organizations contacted by stlb™ to provide any relevant information regarding my current and/or previous employment and I release all persons, schools, employers of any and all claims for providing such information. I understand that misrepresentation and/or omission of facts regardless of when it is found, may result in rejection of this application or, if hired, termination of employment. I understand that nothing contained in this application, or conveyed during any interview which may be granted, is intended to create an employment contract. I understand and agree that my employment is at will, which means that it is for no specific period and may be terminated by stlb™ or me at any time without prior notice for any reason.

Signature *

Clear Signature

Date *

Certification Statement

I certify that all of the information provided on this employment application and all additional sheets and resumes submitted to the stlb™/Premier Board, Inc. (Referred to as “stlb™/PBI”) is true, correct and complete. I understand that false, misleading, incomplete or omitted information on this application, attachments or resumes submitted to stlb™/PBI will result in rejection of this application or termination, if hired, regardless of the date of discovery.

Signature *

Clear Signature

Date *

Equal Opportunity and Affirmative Action Employer

STLB is an Equal Opportunity/Affirmative Action employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, age or any other protected characteristic.

Voluntary Self-Identification of Disability

Form CC-305 • OMB Control Number 1250-0005 • Expires 05/31/2023

Name

Date

Why are you being asked to complete this form?

We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years. Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

You are considered to have a disability if you have a physical or mental impairment of medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: •Autism •Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS •Blind or low vision •Cancer •Cardiovascular or heart disease •Celiac Disease •Cerebral palsy •Deaf or hard of hearing •Depression or anxiety •Diabetes •Epilepsy •Gastrointestinal disorders, for example, Crohn’s Disease, or irritable bowel syndrome •Intellectual disability •Missing limbs or partially missing limbs •Nervous system condition for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS) •Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression

Please check one of the boxes below:

Yes, I Have A Disability, Or Have A History/Record Of Having A Disability
No, I Don’t Have A Disability, Or Have A History/Record Of Having A Disability
I Don’t Wish To Answer

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.

Corpus Christi

4421 Agnes St.
Corpus Christi, TX 78405
Phone: 361.883.6553
Toll free: 888.255.8011
Fax: 361.883.1041
info@stlb.net

Victoria, TX

5602 John Stockbauer Dr,
Victoria, TX 77904
Phone: 361.570.8088

Employment Application

Personal Information

How did you hear about us?

Position Details

General Information

Background Information

California Applicants Only*

Hawaii Applicants Only*

Employment History

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Education History

Consumer Report Authorization

Verification Authorization

Certification Statement

Equal Opportunity and Affirmative Action Employer

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

How do you know if you have a disability?

PUBLIC BURDEN STATEMENT:

stlb™ and Premier Board Inc. Voluntary Self-Identification

Please complete the information requested below. Thank you for your cooperation.

Section 1: General Information

Section 2: Please check all that apply

Voluntary Survey

Corpus Christi

Victoria, TX

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