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Applicant Statement

I understand that should I obtain employment, I agree to conform to the rules and regulations of Myers and Stauffer LC, and its subsidiaries. I also understand that my employment and compensation can be terminated at will (i.e. with or without cause, and with or without notice, at any time, at the option of either Myers and Stauffer LC or myself). I understand that no manager or representative of Myers and Stauffer LC other than the President of Myers and Stauffer LC, has any authority to enter into any agreement for employment other than on an at-will basis.

I certify that, to the best of my knowledge, the answers given by me to the foregoing questions are correct and that the statements made by me in this application are correct without omission of any kind. I understand that any false information contained in this application is cause for discharge at any time during my employment.

I understand that at a later date Myers and Stauffer LC may conduct a background check which may include, but not be limited to: a criminal check, education verification, credit check, and social security number verification. Should Myers and Stauffer LC desire to do so I will be required to provide the necessary consent and release to conduct such background checks and agree that my failure to do so will terminate the employment application process. I understand that an offer of employment will be conditioned on a successful completion of any background check Myers and Stauffer LC chooses to conduct.

I understand that should I become employed that a condition of such employment will be the execution of a confidentiality and/or non-solicitation agreement or such other agreement as required by Myers and Stauffer LC. Prior to my acceptance of employment I understand that I may request to review the agreement applicable to my position.

By my electronic application, I acknowledge I have read and agree to these terms.

Application M&S: *

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Resume Attachment

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Cover Letter
You can use the text area for a cover letter and any supplementary information you would like to provide about your career goals, availability, best times to contact you, etc.

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Personal Information

First Name: *

Street Address: *

Last Name: *

City: *

Middle:

State/Territory: *

Phone #: *

ZIP/Postal code: *

Mobile #:

Country: *

Additional Information

Employment Date Available:
Format: M/D/YY *

Salary Expectations: *

Employment Desired: *

Have you previously applied for employment with Myers and Stauffer LC?

Previously Applied?: *

If applied, when?:

Have you ever been employed by Myers and Stauffer LC?

Previously Employed?: *

If employed, when?:

If employed, name used?:

If employed, title held?:

Are you legally authorized to work in the U.S. for any and all employers?

US Work Authorization: *

If sponsorship needed, please identify the type of sponsorship you are seeking.

Type of sponsored needed:

Please identify family members or members of your household currently employed by Myers and Stauffer LC.

Family Members:

Are you bound by any employment agreements that would prevent you from functioning in the role for which you are applying?

Employment Agreements?: *

What is your highest level of education completed?

Highest Education Level: *

Education:

Education 1 School Name: *

Education 1 City: *

Education 1 State: *

Education 1 Degree or Certificate: *

Education 1 Credit Hours Earned:

Education 1 Major Subject:

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Professional References - Please list those we may contact to verify academic and/or work history:

References 1 Reference Name:

References 1 Years Known:

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References 1 Relationship:

References 1 Phone:

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How did you hear about us?

Source: *

Referred By:

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Certificates/Licenses:

Certificates And Licenses 1 Certificate Name:

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Employment History - List present or most recent first:

Work History 1 Title:

Work History 1 Company Name:

Work History 1 Date From:

Work History 1 Date To:

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Voluntary Equal Opportunity Questionnaire

As an equal opportunity employer, we hire without consideration to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, veteran status or disability. We invite you to complete the optional self-identification fields below used for compliance with government regulations and record-keeping guidelines.

Gender: *

Race: *

Candidate Individual with disabilities: *

Voluntary Self-Identification of Disability

Form CC-305	OMB Control Number 1250-0005
Page 1 of 1	Expires 04/30/2026

Name: Date: Format: MM/DD/YYYY
Employee ID: (if applicable)

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your "major life activities." If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or serious difficulty hearing
Diabetes

Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
Intellectual or developmental disability
Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports

Nervous system condition, for example, migraine headaches, Parkinson's disease, multiple sclerosis (MS)
Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
Partial or complete paralysis (any cause)
Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism)
Traumatic brain injury

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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.

For Employer Use Only

Employers may modify this section of the form as needed for recordkeeping purposes.

For example:

Job Title: _______________

Date of Hire: _______________

Invitation to Self-Identify Protected Veteran Status

This employer is a Federal Government contractor subject to Section 4212 of the Vietnam Era Veteran’s Readjustment Assistance Act of 1974, as amended (Section 4212), which requires Federal Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans.

Our affirmative action policy prohibits discrimination against protected veterans and requires the company to take affirmative action to employ and advance in employment qualified protected veterans at all levels of employment, including the executive level. The following invitation is made pursuant to this policy and the affirmative action obligations required by Section 4212.

Disclosure of this information is completely voluntary and refusing to provide it will not subject you to any adverse treatment. The information will be used only in ways that are consistent with Section 4212. The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restriction on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

INVITATION TO SELF-IDENTIFY
PLEASE ANSWER THE FOLLOWING QUESTIONS

Please indicate whether you identify as one or more of the following protected veteran categories by checking the appropriate box below.

Disabled Veteran: (i) 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 (ii) a person who was discharged or released from active duty because of a service-connected disability.

Recently Separated Veteran: 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.

Armed Forces Service Medal Veteran: 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.

Active Duty Wartime or Campaign Badge Veteran: a veteran who served 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. If you would like more information on campaigns or expeditions for which a campaign badge has been authorized, please visit: http://www.opm.gov/policy-data-oversight/veterans-services/vet-guide/

Veteran Self-ID: *

In addition to our affirmative action obligations under Section 4212, our company values all forms of military service. If you are not a protected veteran, but would like to disclose your status as a member of the Armed Forces, you may do so below. Are you currently serving, or have you served in the Armed Forces of the United States of America (including the Reserves and National Guard)?

Member of Armed Forces?: