**UNITED STATES COURTS FOR THE DISTRICT OF COLORADO**

**Human Resources Division**

**1929 Stout Street, Suite C102**

**Denver, Colorado 80294**

**Telephone: 303-335-2494**

**Facsimile: 303-335-2495**

**APPLICATION FOR EMPLOYMENT**

with the U.S. District Court, U.S. Bankruptcy Court, U.S. Probation
Office (clerical positions only) and Administrative Support Center

The District of Colorado considers applicants for all positions without
regard to race, religion, gender, national origin, age,
handicap/disability, or other legally protected status.

**STOP**: Before completing this application, refer to the vacancy
announcement under the heading How to Apply for other required
documents. Failure to submit the requested information/documents on this
form and in the job vacancy announcement may result in your not being
considered for the position. Applications must be received on or by the
closing date of the vacancy announcement. If a vacancy announcement is
listed as Open Until Filled then applications will be reviewed and
interviews scheduled in the order received. Due to the volume of
applications received, a response confirming receipt of your application
may not be processed for mailing.

Please type or print in ink:

  ----------------------------------------------- -----------------------
  Title of position applying for:                 Vacancy Number:

  ----------------------------------------------- -----------------------

  ----------------------------------------------- -----------------------
  Last Name First Name Middle Initial             Current date:

  ----------------------------------------------- -----------------------

  -----------------------------------------------------------------------
  Other name(s) previously used for employment:

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------
  Mailing Address (including City, State and Zip Code)

  -----------------------------------------------------------------------

+-----------------------------------------------------------------------+
| Contact Information: (Day) (Evening)                                  |
|                                                                       |
| (Cell) (E-mail Address)                                               |
+-----------------------------------------------------------------------+
| Can you travel if a job requires it? \_\_ yes \_\_ no                 |
|                                                                       |
| Are you a U.S. Citizen? ❏ Yes ❏ No *If No, list the country of your   |
| citizenship:*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                 |
|                                                                       |
| The federal immigration and appropriations law significantly limits   |
| the circumstances in which the federal judiciary may employ a         |
| non-citizen of the United States. Therefore the U.S. Courts is        |
| responsible for ensuring that all new employees are eligible to work  |
| in the United States by reviewing one of the employment eligibility   |
| documents specified on the Form I-9 (Employment Eligibility           |
| Verification) before placing the selected candidate on federal        |
| payroll.                                                              |
+-----------------------------------------------------------------------+
| **Minimum annual salary requirement:                                  |
| \$**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                  |
|                                                                       |
| **Date available for employment**:                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_      |
+-----------------------------------------------------------------------+
| **How did you learn about us?**                                       |
|                                                                       |
| **\_\_ USAJobs.com \_\_\_ Court's website \_\_ Other**                |
+-----------------------------------------------------------------------+
| Do you have any relatives who are judges, officers or employees of    |
| the U.S. Courts? ❏ Yes ❏ No                                           |
|                                                                       |
| If yes, give name, position and relationship to you:                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\                                         |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                              |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **FBI fingerprinting and subsequent background check is mandatory for |
| the applicant selected to fill the vacancy for which you are          |
| applying. Final determination of employment suitability is based on   |
| background check results and approval of the hiring Court Unit        |
| Executive.**                                                          |
|                                                                       |
| Have you any criminal convictions or are you currently involved in    |
| any misdemeanor or felony proceedings? ❏ Yes ❏ No                     |
|                                                                       |
| If yes, give details of conviction(s) and deposition(s) in the space  |
| below and/or provide description of any pending proceedings. You may  |
| omit: (1) offenses committed before your 18^th^ birthday and          |
| adjudicated under a juvenile offender law; (2) offenses as to which   |
| the record has been judicially expunged; (3) minor traffic violations |
| for which you paid a fine of \$150 or less.                           |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Have you ever been discharged from a position, asked to resign under  |
| the threat of discharge or been debarred from federal employment by   |
| the Office of Personnel Management?                                   |
|                                                                       |
| ❏ Yes ❏ No                                                            |
|                                                                       |
| If yes, please explain:                                               |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\                                                       |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Are you delinquent on any federal debt, such as delinquencies arising |
| from federal taxes, loans, overpayment of benefits, and other debts   |
| to the U.S. Government, plus defaults of federally guaranteed or      |
| insured loans such as student and home mortgage loans? ❏ Yes ❏ No     |
|                                                                       |
| If yes, provide the type, length and amount of the delinquency or     |
| default and steps that you are taking to correct the error or repay   |
| the debt.                                                             |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| Have you ever been employed by the federal judiciary? ❏ Yes ❏ No      |
|                                                                       |
| If yes, provide name of agency, position and title:                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                                       |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+
| Have you ever been employed by a federal agency? ❏ Yes ❏ No           |
|                                                                       |
| If yes, provide name of agency, position and title:                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                                       |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**Employment Experience**

Start with your present or most recent job, you may include military and
volunteer experience, and work back 10 years. "See Resume" is
unacceptable. You may disregard organizations which indicate race,
religion, gender, national origin, handicap/disability or other
protected status.

+----------------------------------+-----------------------------------+
| Employer Name:                   | Dates of Employment (month/year)  |
|                                  |                                   |
|                                  | From: To:                         |
+----------------------------------+-----------------------------------+
| Job Title:                       | Average number of hours per day:  |
+----------------------------------+-----------------------------------+

+----------------------------------+-----------------------------------+
| Address:                         | Starting Salary:                  |
|                                  | \$\_\_\_\_\_\_\_\_\_\_            |
|                                  | per\_\_\_\_\_\_\_\_\_             |
|                                  |                                   |
|                                  | Ending Salary:                    |
|                                  | \$\_\_\_\_\_\_\_\_\_\_            |
|                                  | per\_\_\_\_\_\_\_\_\_             |
+----------------------------------+-----------------------------------+

  ---------------------------- ----------------------- ------------------
  Supervisor's Name:                                   

  ---------------------------- ----------------------- ------------------

  ---------------------------- ----------------------- ------------------
                               Telephone Number:       Kind of business:

  ---------------------------- ----------------------- ------------------

+-----------------------------------------------------------------------+
| Reason for leaving:                                                   |
+-----------------------------------------------------------------------+
| Description of                                                        |
| work:\_\_\_\_\_                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+

+----------------------------------+-----------------------------------+
| Employer Name:                   | Dates of Employment (month/year)  |
|                                  |                                   |
|                                  | From: To:                         |
+----------------------------------+-----------------------------------+
| Job Title:                       | Average number of hours per day:  |
+----------------------------------+-----------------------------------+

+----------------------------------+-----------------------------------+
| Address:                         | Starting Salary:                  |
|                                  | \$\_\_\_\_\_\_\_\_\_\_            |
|                                  | per\_\_\_\_\_\_\_\_\_             |
|                                  |                                   |
|                                  | Ending Salary:                    |
|                                  | \$\_\_\_\_\_\_\_\_\_\_            |
|                                  | per\_\_\_\_\_\_\_\_\_             |
+----------------------------------+-----------------------------------+

  ---------------------------- ----------------------- ------------------
  Supervisor's Name:                                   

  ---------------------------- ----------------------- ------------------

  ---------------------------- ----------------------- ------------------
                               Telephone Number:       Kind of business:

  ---------------------------- ----------------------- ------------------

+-----------------------------------------------------------------------+
| Reason for leaving:                                                   |
+-----------------------------------------------------------------------+
| Description of                                                        |
| work:\_\_\_\_\_                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+

+----------------------------------+-----------------------------------+
| Employer Name:                   | Dates of Employment (month/year)  |
|                                  |                                   |
|                                  | From: To:                         |
+----------------------------------+-----------------------------------+

  ---------------------------------- ------------------------------------
  Job Title:                         Average number of hours per day:

  ---------------------------------- ------------------------------------

+----------------------------------+-----------------------------------+
| Address:                         | Starting Salary:                  |
|                                  | \$\_\_\_\_\_\_\_\_\_\_            |
|                                  | per\_\_\_\_\_\_\_\_\_             |
|                                  |                                   |
|                                  | Ending Salary:                    |
|                                  | \$\_\_\_\_\_\_\_\_\_\_            |
|                                  | per\_\_\_\_\_\_\_\_\_             |
+----------------------------------+-----------------------------------+

  ---------------------------- ----------------------- ------------------
  Supervisor's Name:           Telephone Number:       Kind of business:

  ---------------------------- ----------------------- ------------------

+-----------------------------------------------------------------------+
| Reason for leaving:                                                   |
+-----------------------------------------------------------------------+
| Description of                                                        |
| work:\_\_\_\_\_                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+

If sufficient space is not available when providing requested
information, please attach a separate sheet of paper identifying the
information with the corresponding topic.

**Education**

Do you have a high school diploma or G.E.D. equivalent? ❏ Yes ❏ No

Name of school
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
City/State \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  ------------------------ --------- ---------- ------------------- ----------
  Name and location of     Number of            Degree              Overall
  undergraduate and        credit                                   grade
  graduate colleges or     hours                                    point
  universities attended                                             average

                           Quarter   Semester                       

                                                                    

                                                                    

                                                                    
  ------------------------ --------- ---------- ------------------- ----------

Describe any honors, specialized training, apprenticeship, skills,
including machines/equipment which relates to the position for which you
are applying:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Typing Speed: w.p.m. \_\_\_\_\_\_\_

PC Skills (list operating system(s) and /or software)?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Lotus Mail (e:mail) \_\_\_\_

WordPerfect - version \_\_\_\_

Other software applications? Please list:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  ----------------- ----------------- ----------------- -----------------
  Rate your foreign Fluent            Effective         Limited
  language skills                                       
  (other than                                           
  English)                                              

  SPEAK                                                 

  READ                                                  

  WRITE                                                 
  ----------------- ----------------- ----------------- -----------------

List professional, trade, business or civic activities, and office(s)
held. You may exclude memberships which would reveal race, gender,
religion, national origin, age, ancestry, handicap/disability, or any
other legally protected status:

**Professional / Employment Related References**

Provide the information below for three employment related references
that you authorize the U.S. Courts to contact (Do not include personal
references.)

1.  Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
    Telephone: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Association:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Years of Acquaintance:\_\_\_\_\_\_\_\_\_\_\_\_\_

2.  Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
    Telephone: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Association:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Years of Acquaintance:\_\_\_\_\_\_\_\_\_\_\_\_\_

3.  Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
    Telephone: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Association:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Years of Acquaintance:\_\_\_\_\_\_\_\_\_\_\_\_\_

**Applicant's Signature**

I understand that if I am employed, I will be an employee-at-will, which
means that the employment relationship is terminable at will. There is
no contract of employment for any particular time or upon any particular
terms or conditions. I will have the right to terminate the employment
at any time for any reason and the U.S. Courts, District of Colorado
(hereafter the "Court") will have the same right. I understand that this
policy of at-will employment will not be modified.

I voluntarily and knowingly authorize any past employer or supervisor,
college, university or other institution of learning, administrator,
state agency, federal agency, private business, personal reference,
and/or other persons, to give records or information they may have
concerning motor vehicle history, earnings history, character, and
employment records or any other information requested by the Court or
any agent named by the Court.

I certify that my statements on this application and my responses to all
of the foregoing questions are true and correct to the best of my
knowledge, and there is no information that I have omitted,
misrepresented or failed to include. If any of my statements or
responses on this application are found to be untrue, misrepresented or
omitted, I understand that such a finding may result in the rejection of
my application, and, if employed, my immediate discharge or discharge at
any time during my employment and may be punishable by fine or
imprisonment. I understand, also, that I am required to abide by all
rules and regulations of the employer.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature of applicant Date