State of Maine Employment Application - Free Download | Page 6
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State of Maine Employment Application Page 6
State of Maine Employment Application
Page 6 of 8 PER 3 - 12/08
The State of Maine conducts background checks.
Have you ever been convicted of any violation of law by any court of law Include any guilty pleas entered,
military courts martial, traffic violation convictions for Operating Under the Influence (OUI), or traffic
violations that resulted in your license being suspended. Do not include any conviction(s) occurring before
your 18th birthday or traffic violations not listed above.
Please print your answer (either “Yes” or “No”) in the space provided: __________
If yes, please list: Offense(s) Date of Conviction(s)
___________________________________________________ __________________
___________________________________________________ __________________
___________________________________________________ __________________
___________________________________________________ __________________
Not all conviction(s) will automatically disqualify you from employment but will be considered in relation to
specific job requirements. Omission or misrepresentation of this information will result in employment
Please read and sign the following statement: I certify, under penalty of law, that the
information given in this application is correct and complete to the best of my knowledge. I am
aware that, should investigation at any time show falsification, I will not be considered for
employment or, if employed, I may be dismissed. I hereby authorize the State of Maine, the
Department of Administrative and Financial Services, Bureau of Human Resources and agencies to
whom my name is certified/referred to make all necessary investigations concerning me, my work
habits, character, or my action in any transaction. I authorize the State of Maine to check my
driving record if the position for which I am applying requires driving. I understand that I may be
asked to submit to a pre-employment drug test, a credit history check and/or a criminal history
background check as a condition of employment. I authorize the Bureau of Human Resources or its
assignee to receive and make available to other state agencies my academic records or other
material pertinent to my qualifications, and further authorize and request each former employer,
person given as reference, educational institution or organization (including law enforcement
agencies) to provide all information that may be sought in connection with my application. I
understand and agree that I will be required to ratify the information contained in this application
by signature as a condition of employment.
Signature_______________________________________________ Date __________________
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