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Employment Application

Employment Form

Education Background

Professional Work References

Prior Work History [list more recent first]

The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex, or national origin. Age Discrimination in Employment Act of 1967 prohibits discrimination because of age. Thank you for completing this application and for your interest in employment with Lewis County Head Start. Please be assured that your opportunity for employment will be given every consideration. Applicant’s Certification for Agreement (Please read carefully) I hereby certify that the facts set forth in this employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal.