Name of Applicant ______________________
ASPS/HRD-FA3.01 10/12 1 of 7
Arizona State Personnel System
APPLICATION FOR EMPLOYMENT
Completion of this form in no way constitutes an offer of employment. The information requested is
required to provide us with information necessary to consider you for the position for which you are
DATE OF APPLICATION _____________________________
PLEASE PRINT LEGIBLY OR TYPE ALL REQUESTED INFORMATION
Position for which you are applying _______________________________________________
Last Name First Name M.I.
Street Address City State Zip Code
Contact Phone Number(s) (include area code) Contact E-mail Address
Alternate Phone Number(s) (include area code) State Agency Applying To
CONDITIONS OF CONSIDERATION FOR EMPLOYMENT
All information contained on the application is subject to verification. If applicable, the State of Arizona may
conduct background checks including, but not limited to, work references, driving records, criminal conviction
records and educational attainment.
You may be subjected to a criminal background investigation for some positions. If applicable, your fingerprints
may be sent to state and federal law enforcement agencies (DPS and FBI). All offers of employment and
continued employment may be subject to a complete review of any criminal convictions you may have. Your
failure to make a full and accurate disclosure of any prior conviction(s), or to answer the questions fully and
accurately, may result in immediate termination from employment or the rejection of any pending application or
offer from the State of Arizona.
CRIMINAL BACKGROUND INFORMATION (ALL APPLICANTS)
ALL QUESTIONS MUST BE ANSWERED TRUTHFULLY AND COMPLETELY. “Crime” as used in this section
means any and all felonies, misdemeanors and serious driving offenses, including but not limited to driving while
under the influence of intoxicating liquor (“DUI”) or drugs, extreme DUI, reckless driving, aggressive driving,
racing/exhibition of speed, excessive (criminal) speed, leaving the scene of an accident, driving on a suspended,
revoked or refused license or any other driving offense that is a misdemeanor (i.e., possible penalty for conviction
includes imprisonment or jail time). “Crime” does not include minor (civil) traffic offenses. If you are not sure how
to answer these questions, please ask a member of the Human Resources Department for assistance.
“Convicted” means you have been found guilty of a crime by a court or jury, or have pleaded guilty or
nolo contendere (“no contest”) to a crime and have been sentenced for a crime, whether imprisoned,
incarcerated, placed on probation, fined or received a suspended sentence.
**NOTE: A criminal conviction(s) may or may not constitute an automatic disqualification for employment.
Have you ever been convicted of any crime? Answer by writing “Yes” or “No” _________
If you have answered “yes” to this question, please give the details of offense(s) for which convicted, date(s) of conviction(s),
jurisdiction(s) (court, city, county, state, federal, foreign or military), and disposition(s) on the attached supplemental sheet
marked “Criminal Conviction History Form”. Exclude tickets for minor traffic and parking violations.