Are you eligible to work in the United States? *
If other Sponsorship is required, Please list below. *
Name of Institution(s) Attended *
Most Recent Company Name *
Most Recent Company Location *
Most Recent Company Phone Number *
Most Recent Job Title *
Dates of Employment *
Asking Salary *
Reasons for Leaving *
Past Company Name *
Past Company Location *
Past Company Phone Number *
Past Job Title *
Dates of Employment *
Reason for Leaving *
Have you ever been employed by Booker? *
Have you ever interviewed at Booker *
Please Read Carefully and Write your Initials That You Understand and Accept This Information: I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts in this form or any interview, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Booker to investigate, without liability, all statements contained in this application and supporting materials. I hereby release Booker and all affiliated persons and entities, as well as any person or institution that provides Booker with any lawful information about me, from any and all liability whatsoever resulting from any such lawful inquiry, investigation or communication. I authorize references, former employers and education institutions, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I agree to execute any consent forms necessary for Booker to conduct its lawful pre-employment checks. I understand that this document is NOT an offer of employment and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that employees of Booker serve at-will and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, and to comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits (temporary employees that work 25 hours or more are eligible to participate in the company medical plan) including paid time off. If employed on a regular, benefits-eligible basis, I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. If employed, I agree to comply with all Company rules and regulations. I understand that, if employed I will have access to, acquire knowledge of and be entrusted with many confidential details about Booker and its customers and breach of such confidentiality on my part may be cause for termination of employment. *
CALIFORNIA APPLICANTS ONLY: I understand the Company may obtain, without using the services of a third party investigative consumer reporting agency, public records pertaining to my character, general reputation, personal characteristics or mode of living during its evaluation of my application for employment and, if employed, during my employment. By typing my initials, I waive my right to receive copies of public records obtained by the Company. If employed on a regular, benefits-eligible basis, I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. If employed, I agree to comply with all Company rules and regulations. I understand that, if employed I will have access to, acquire knowledge of and be entrusted with many confidential details about Booker and its customers and breach of such confidentiality on my part may be cause for termination of employment. *
U.S. Equal Opportunity Employment Information (Completion is voluntary)
Individuals seeking employment at Booker are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation. You are being given the opportunity to provide the following information in order to help us comply with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.
Completion of the form is entirely
voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.
Please select Male
Decline To Self Identify
Are you Hispanic/Latino?
Please select Yes
Decline To Self Identify
Please identify your race
Please select American Indian or Alaskan Native
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
Two or More Races
Decline To Self Identify
Race & Ethnicity Definitions
If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows:
A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.
A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Please select I am not a protected veteran
I identify as one or more of the classifications of a protected veteran
I don't wish to answer
OMB Control Number 1250-0005
Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities
1. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.
How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or 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:
Blindness Deafness Cancer Diabetes Epilepsy Autism Cerebral palsy HIV/AIDS Schizophrenia Muscular dystrophy Bipolar disorder Major depression Multiple sclerosis (MS) Missing limbs or partially missing limbs Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation)
Please select Yes, I have a disability (or previously had a disability)
No, I don't have a disability
I don't wish to answer Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
1Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
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.