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Verizon Wireless Job Application Form

Individuals seeking to be employed and assigned at a Verizon Wireless store must fulfill this form. To submit, interested individuals should introduce themselves to the site manager and personally hand over the completed form.

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Dear Applicant: 
 
Thank you for your interest in employment with Verizon.  As part of our application process, we are 
providing an Employment Application for your completion.  
 
o Please use blue or black ink  to complete the Employment Application.   
 
o  Complete the entire application.  All  requested information requires a response. 
 
o Write “N/A” (or “Not Applicable” ) for requested information t hat does not apply to you.  
 
o Write “Information Unavailable”  when you do not have the requested information and you are 
unable to obtain it. Provide the reason why the information is unav ailable.  For example: If a 
former employer is no longer in business, you  should provide as much information as possible, 
including the name of the company, department, titl e/work duties, last salary, dates employed, 
reason for leaving, and the supervi sor’s name.  However, if you are unable to obtain the 
telephone number and address, you should write  “Information Unavailable – company 
closed”.   
 
o  Carefully read page 4 of the Em ployment Application regarding certain state laws before 
completing the Criminal Record  portion of the application.  Be sure the information you provide 
about prior convictions is accurate and complete. 
 	
o  	Note: If you have entered a plea of guilty,  you may have a record of conviction.  
Convictions include even seemingly minor viol ations, i.e., driving without a seatbelt or 
littering.   You must also include instanc es when you paid a fine for a traffic and/or 
motor vehicle violation.	
 	
 
 
 
 	
Please review each page of the applic ation carefully.  Failure to provide 
complete and accurate information on this  application could make you ineligible 
for hire or be a cause for termination if you are hired.     	 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    1

Verizon Application - Applicant Guide 	
 
 	
1. 	The Application - If you make a mistake, draw one line through th e mistake, write your correction, and then write 
your initials by the change.  If a sect ion does not pertain to you, you may write  N/A in that section.  DO NOT use 
N/A if you simply do not k now/remember information.  	
N/A is only used if a section does not apply to you.	 	
 
2. 	Page 1 – Education section. Make sure to complete this se ction as requested.  Include “course of study” (usually 
General) and GPA.  If you do not remember your GPA, pr ovide your average grade, for example “B Average”.  	
 
3. 	Page 2 – Work Experience. Please be sure to complete this as  requested. Start with your most recent employment 
status and include all requested information. If you attende d school during a time period, enter the dates you were 
in school, then enter “full time student”.  Periods of  unemployment should be handled the same way.  If you 
worked for a company that has closed, enter name of co mpany, city and state, and enter “information unavailable - 
company closed” for phone number, supervisor, etc.       	
 	
If the job for which you are applying r equires a Commercial Driver’s Licens e (CDL) and you already have a CDL, 
list an additional five (5) years of employment [for a total of  ten (10) years].  If you do not have a CDL or the job for 
which you are applying does not require a CDL, you may lis t additional work experience beyond the five (5) years 
[for a total of ten (10) years] if you believe it is relevant to the job for which you are applying.  
 
If you were not self-employed, enter N/A in this section.   If you were not an employee of Verizon, check the “no” 
box and enter N/A in that section.      
 
If the position requires testing, please ask your test admi nistrator for assistance if you have any questions.  THIS 
IS A VERY IMPORTANT PART OF YOUR APPLICATION.  Getting  all the information correct will insure that your 
information is reviewed in a timely manner.  If your wo rk history does not fit on Page 2, please ask the test 
administrator for additional copies of that page.   	
 
4. 	Page 3  – If you have no military experience, ent er N/A in this section.  If you have military experience, ask the test 
administrator for a military form. 	
 	
In the section that asks you to “Review the skills belo w to identify those you possess”, “L - Low” does not mean 
“none”.  If you have no experience in any of these areas, leave  it blank - do not check “L”.  The last question asks if 
you have a security clea rance.  Those applicants with a security clearance will kn ow if this question applies to 
them.  Those who have a security  clearance typically have military or  federal government work history. 	
 
5. 	Page 4 – Criminal Record.  Misdemeanors and felonies – list all since age 18.  Be sure to read the entire section 
carefully, and include any required information (including  docket numbers, dates, and the dispositions).  If the 
docket number is not known, please contact the cour thouse and obtain the number from the Court Clerk. 	
 
6. 	Page 5 – List all violations  of motor vehicle laws/ordinances (other  than parking violations) of which you have 
been convicted or forfeited bond or collateral during  the past 3 years. If you have been charged with a violation of 
motor vehicle laws/ordinances and you are awaiting a trial or other disposition, indicate the offense charged and 
the expected date of trial or other disposition.  If you  are applying for a job in California, Massachusetts or Rhode 
Island, see section on page 4 under “Criminal Record” for tr affic offenses which you do not need to disclose.  You 
do not have to report any offenses for which you have  been arrested or charged, but that did not result in a 
conviction. Please be certain to include the violation, t he date, and the disposition (e.g. “fine paid”, “reduced to 
non-moving violation”, etc.). 	
 
7. 	Page 6  – Be sure to read this page and then answer “yes” or “no” at the bottom.  Sign and date in the lower left 
corner of the page, unless you re side in the state of Maryland. 	
 
8. 	Page 7 – If you do not want to provide the Gender and Race/E thnic Group information, you must so indicate at the 
top of the page by writing your initials on the line.  Regardless if you elect to provide the information on this page, 
please be sure to still fill in the “Application Date” and “Social Security Number” boxes.  The Race and 
Gender/Ethnic Group information is not used for hiring decisio ns; it is used to comply with Federal laws concerning 
Affirmative Action.  Please either self-identify OR initia l this page, do not do both.   If you choose to indicate 
Race/Ethnic Group, please select only one ca tegory for Race/Ethnic group information. 	
    2

1 
Employment Application 	
4/2007 	 	 Please note that by submitting this applicat ion, you may be considered for available pos itions in multiple Verizon Communications Companies 
unless otherwise specified by you.  Veriz on Companies are Equal Opportunity Affirmativ e Action Employers.  Unlawful discrimination because of 
age, color, citizenship status, disability,  disabled veteran status, gender, marital status, national origin, race, religion, s exual orientation, Vietnam-era 
veteran status or any other characteristic protected by applicable law is prohibited.  If you believe you have been discriminat ed against, you may 
notify the Equal Employment Opportunity Commission, the Federal  Communications Commission, the Employment Standards Administration and/or 
other appropriate federal, state or local agencies. 
 Please be careful when completing your Verizon Employment Application.  Answer all questions on this application completely and  
accurately.  Failure to provide completely accurate information could make you ineligible for hire or be a cause for terminatio n if you are 
hired.  Verizon Communications, at its discretion, may consider your application for employment after this date. 
 
Name (Last, First, MI) 	Social Security Number 	
      	      	
Present Address (Number/Street, Apt./Floor #) 	City 	State 	Zip 	
     	 	     	 	     	 	     	 	
Telephone No. (day) 	  Home 	  Work 	  Cell 	Telephone No. (evening) 	  Home 	  Work 	  Cell 	
     	 	     	 	
Telephone No. (other) 	Email Address (optional) 	May we contact you at your current employer? 	
     	 	     	 	   Yes       	   No 	
Are you legally authorized to work in the 
United States? 	Are you under 18 years of age? 	Will you now or in t he future require sponsorship for employment visa 
status (ex: H-1B)? 	
   Yes     	   No 	   Yes    	   No 	   Yes    	    No 	
What are your salary expectations? 	Please indicate your work location / geographic preference: 	When will you be available to st art work? 	
$ 	      	Primary choice  	      	(City & State)	 	 	
Secondary choice  	      	(City & State)	 	
per  	 Hour 	 Immediately   	     	  Within two weeks of job offer 	   	        Annual 	  Two weeks or more from job offer 	  	 	 	 	
Type of position sought: 	Indicate the type of position desired (if known):          	 Management   	 Associate 	
  Indicate job title:  	     	 	
 	   Full-Time   	    	  Part-Time 	
  Temporary     	  Summer 	 	
Were you ever an  employee of Verizon or an affiliate company (i.e., former Bell  Atlantic or GTE, Verizon Wireless, Verizon Business, etc)? 	  Yes         	  No 	
If yes: 	Name of Company 	      	Last Salary 	      	Job Title 	      	 	
 	Supervisor 	      	Supervisor’s Location (city/state) 	      	 	
 	Dates Employed 	From (mm/yy) – To (mm/yy) 	        	- 	      	Reason for Leaving 	      	 	
EDUCATION Name of High School 	City 	State 	
     	 	     	 	     	 	Course of Study 	GPA/scale 	Did you graduate? 	
      	      	  Yes     	  No 	Highest grade completed 
  9 	  10 	  11 	  12 	  GED (City/State of Testing Center) 	      	GED Agency Name 	      	 	
Name of Under	graduate Colle	ge/Universit	y or Trade School 	City	State 	
     	 	     	 	     	 	Course of Study/Degree  	GPA/scale 	Did y ou graduate? 	Type of diploma/certificate 	
  Yes     	  No 	      	      	      	Dates Attended 	Years completed 	Credits Completed  	
From 	      	 	To 	      	 	  1          	  2          	  3          	  4 	      	
Name of Under	graduate Colle	ge/Universit	y or Trade School 	City	State 	
     	 	     	 	     	 	Course of Study/Degree  	GPA/scale 	Did you graduate? 	Type of diploma/certificate 	
  Yes     	  No 	      	      	      	Dates Attended 	Years completed 	Credits Completed  	
From 	      	 	To 	      	 	  1          	  2          	  3          	  4 	      	
Name of Graduate Colle	ge/Universit	y or Trade School 	City	State 	
     	 	     	 	     	 	Course of Study/Degree  	GPA/scale 	Did you graduate? 	Type of diploma/certificate 	
  Yes     	  No 	      	      	      	Dates Attended 	Years completed 	Credits Completed  	
From 	      	 	To 	      	 	  1          	  2          	  3          	  4

2 
Name 	 	Social Security Number 	
      	 	      	 
WORK EXPERIENCE 
List all employers for the past five (5)  years, including cooperative and summer work.   You may also list volunteer work.  If unemployed during the  5-year period, list dates of unemployment.  If self-employed,  list dates and include clients that may be contacted for verifica tion (space is provided at 
the end of this section).  The entire five (5) year period must  be accounted for.  In addition, you may indicate if information  on your work experience 
is available under a different name (this w ill facilitate verification of your answer). 
 If the job for which you are applying requires a Commercial Driver’s License (CDL)  and you already have a CDL, list an additional five (5) 
years of employment [for a total of ten (10) years].   If you do not have a CDL or the job for which you are applying does not require a CDL,  you 
may list additional work experience beyond the  five (5) years [for a total of ten (10) years] if you believe it is relevant to the job for which you are 
a
pplying. 	
LIST MOST RECENT JOB FIRST Name of Company 	Address ( number/street/city/state/zip) 	
      	      	Supervisor name and phone number 	Title/work duties 	
      	      	Dates employed (From/To) 	Last salary 	Reason for leaving 	
      	      	      	
Name of Com	pany 	Address 	(number/street/cit	y/state/zi	p)	
      	      	Supervisor name and phone number 	Title/work duties 	
      	      	Dates employed (From/To) 	Last salary 	Reason for leaving 	
      	      	      	
Name of Com	pany 	Address 	(number/street/cit	y/state/zi	p)	
      	      	Supervisor name and phone number 	Title/work duties 	
      	      	Dates employed (From/To) 	Last salary 	Reason for leaving 	
      	      	      	
Name of Com	pany 	Address 	(number/street/cit	y/state/zi	p)	
      	      	Supervisor name and phone number 	Title/work duties 	
      	      	Dates employed (From/To) 	Last salary 	Reason for leaving 	
      	      	      	
Name of Com	pany 	Address 	(number/street/cit	y/state/zi	p)	
      	      	Supervisor name and phone number 	Title/work duties 	
      	      	Dates employed (From/To) 	Last salary 	Reason for leaving 	
      	      	      	
Name of Com	pany 	Address 	(number/street/cit	y/state/zi	p)	
      	      	Supervisor name and phone number 	Title/work duties 	
      	      	Dates employed (From/To) 	Last salary 	Reason for leaving 	
      	      	      	
Name of Com	pany 	Address 	(number/street/cit	y/state/zi	p)	
      	      	Supervisor name and phone number 	Title/work duties 	
      	      	Dates employed (From/To) 	Last salary 	Reason for leaving 	
      	      	      	
If you are currently employed, may we contact your employer and/or supervi sor to conduct a reference check? 	    	  Yes             	  No 	
If yes:          Please list name and phone number of individual to be contacted. 	      	 	
If self-employed, list client reference and telephone number. 	
Client(s) 	Dates (From/To) 	Telephone Number 	
      	      -       	      	
      	      -       	      	
      	      -       	      	
      	      -

3 
Name 	 	Social Security Number 	
      	 	      	 
U.S. MILITARY SERVICE/EXPERIENCE (DO NOT INCLUDE ROTC)  
Date of Discharge (mm/ dd/yy) 	Branch of Service 	
     	 	     	 	Occupational Specialization 	Grade/Rank at Discharge 	
     	 	     	 	Special/Technical Training 	Special/Technical Training Dates of Attendance (From/To) 	
     	 	     	 	Type of Discharge (honorable, general, other than honorable) 	M i l i t a r y Occupational Skill (MOS) Long Title 	
     	 	     	 	
Are you fluent in a language other than English?  (answering this question is optional) 
      
Review the skills below to identify 	only	 those you possess.  For those skills you po ssess, check the corresponding block to indicate your proficiency for that particular skill. 	
L - Low 	M - Medium 	H - High 	
L 	M 	H 	 	L 	M 	H 	 	L 	M 	H 	 	
 	 	 Building Maintenance 	CAD 	 	 Cable TV/CATV Installation 	
 	 	 Customer Service 	Data Input 	 	 Electrical / Electricity 	
 	 	 Electronics 	Equipment Calibration 	 	 Heavy Equipment Operator 	
 	 	 Keyboard (Windows environment) 	Mechanical 	 	 PC Literacy 	
 	 	 Pole Climbing 	Presentation Skills 	 	 Project Management 	
 	 	 Sales 	Software Engineering Skills 	 	 Team Building 	
 	 	 Vehicle Maintenance 	Word Processing 	 	 Other 	      	
Indicate below any License(s) or Certificate(s) you possess.  If you have a license/certificate that is not listed, mark the sq uare for “Other” and print the name of 
License/Certificate in the space provided. 
 ASE Certification in Refrigerant Recovery 	Boiler Fireman’s License 	Certified Compensation Professional 	
 Certified Contract Manager 	Certified Management Accountant 	Certified Private Fleet Manager 	
 Certified Public Accountant 	Certified Purchasing Manager 	Certified Quality Engineer 	
 Certified Reliability Engineer 	Commercial Driver’s License 	Data Certification 	
 DC Engineer’s License Class 3 	DC Engineer’s License Class 6 & 8a 	Facility Management Associate 	
 Forklift Certification 	High Pressure Steam License 	IT Certification (type) 	      	
 Master Electrician 	Nortel Certification 	Professional Engineer 	
 Project Management Certification 	Radio License (type) 	      	Worker’s Compensation Representative 	
 Refrigeration License/Heating, Air Conditioning, 	Licensed Smog Check Mechanic 	Micro-station Computer Aided 	 	Ventilation License 	 	 	 	Drawing Certificate 	
 SPHR or PHR (Professiona l in Human Resources) 	Other 	      	
Verizon Communications does not permit empl oyees to work in organizations or functions that are directly or indirectly managed  or supervised by relatives, members of 
their household, or persons with whom they have a close personal re lationship.  Do any of your relatives, members of your household, or persons with whom you have a 
close personal relationship work for Verizon? 
  Yes 	  No 	 	If yes, provide name, relationship and work location 	           	
       
Have you previously applied for a job with Verizon (or the fo rmer Bell Atlantic or GTE or any of their subsidiaries)? 
  Yes 	  No 	 	
If yes: 	Date 	      	 	
Name of Company 	      	 	
City/State 	      	 	
For positions that require a security clearance: Do you hold a security clearance? 
  Yes 	  No 	Type of clearance

4 
Name 	 	Social Security Number 	
      	 	      	 
CRIMINAL RECORD 
If you are applying for a job in Hawaii :  DO NOT COMPLETE THIS PAGE UNTIL REQUESTED TO DO SO.  
 If you are applying for a job in California: You are not required by California to pr ovide information concerning: * An arrest or detention that did not result in conviction.   (However, you are required to provide information concerning an ar rest for which you are 
out on bail or on your own recognizance pending trial); 
* A referral to, and participation in, any pre-trial or post-trial diversion program; * Convictions for the following marijuana-related offenses that  are more than two years old: (i) the misdemeanor possession of  marijuana (other than 
concentrated cannabis); (ii) giving away,  offering to give away, transporting, offering to transport, or attempting to transport not more than 28.5 
grams of marijuana (other than concentrat ed cannabis); (iii) possessing paraphernalia used to  inject or smoke marijuana; (iv) being present in a 
place where marijuana is used;  (v) using or being under the influence of marijuana; 
* Convictions for which the record  has been judicially ordered sealed, expunged, or statutorily eradicated; * Misdemeanor convictions for wh ich (i) probation has been successfully completed (o r otherwise discharged) and (ii) the case has been judicially 
dismissed; 
* Any arrest for which a pre-trial divers ion program has been successfully completed; Reporting of any of the above information prior to employment  is strictly voluntary for California applicants and non-disclosure of this information will 
not be considered in the employment process. 
 If you are applying for a job in Massachusetts :  You  must answer “No” if your criminal record consists  only of one or more of the following:  (a) 
misdemeanors in which the convictions occurred or the completion of  any period(s) of incarceration resulting therefrom (if later) occurred five or 
more years ago (b) misdemeanor convictions li mited to a first offense for drunkenness, simple assault, speeding, minor traffic violations, disturbance 
of the peace or affray (c) minor traffic violations other t han reckless driving, driving to endanger and motor vehicle homicide  and (d) if a charge was 
continued without a finding.  An applicant for employment with a sealed record on file with the commissioner of probation may a nswer “no record” 
with respect to any inquiry herein relative to prior arrests, criminal court appearances or convictions.  In addition, any appl icant for employment may 
answer “no record” with respect to any inquiry relative to prio r arrests, court appearances or adjudications in all cases of delinquency or as a child in 
need of services which did not result in a complaint trans ferred to the superior court for criminal prosecution. 
 If you are applying for a job in Rhode Island :  You may answer “No” if your criminal record consists only of plea(s) of “no contest” or “nolo 
contendere,” you received only probation and served t he entire probation without any violation. 
 All applicants:  Read the application carefully and be sure that the information you provide about prior convictions is complete, true and 
includes even seemingly minor violations. 
 The fact that you may have a record of convictions will not necessarily bar you from employment .  Unless specified differently above, “Conviction” 
includes a plea of guilty, “no contest” or “nolo contendere.”   If you have been charged with a crime and you are awaiting trial  or other disposition, 
answer “yes.”  If you were charged with a crime, but the charges  were dropped, answer “no.”  Traffic offenses are addressed in separate questions 
of the application.  You may answer “no”  to any convictions that were expunged. 
Have you ever been convicted of, or are you awaiting trial  disposition on a Felony, Misdemeanor or Summary Offense?  
 Yes    	 No 	
Are you currently on pretrial probation or conditional discharge or  in an alternative rehabilitative program where you will be subject to trial if you do not 
successfully complete the probation or  alternative rehabilitative program? 
 Yes    	 No 	
If you answered “Yes” to either of the questions above, provide the following information: 	 	Nature of Offense 	    	
 	City/County/State 	    	
 	Docket No. 	 	(i.e. Cause/Case 
No. as appropriate) 	
 	Conviction  Date 	
  	
 	Probation  End Date 	 	(if applicable) 	 	
Sentence  (If awaiting trial/disposition, 
or completion of pretrial probation or 
alternative rehabilitative program, give 
expected trial/disposition or completion 
of probation/program.)

5 
Name 	 	Social Security Number 	
      	 	      	 
DRIVER’S LICENSE & DRIVING RECORD 
All Applicants must complete this section  List  ALL VIOLATIONS  of motor vehicle laws/ordinances  (OTHER THAN PARKING VIOLATIONS)  of which you have been convicted or forfeited 
bond or collateral during the past 3 years.  Unless specified  differently on the proceeding page “Conviction” includes a plea of “guilty,” “no contest” or 
“nolo contendere.”  Your driving record will be che cked if you are applying for a driving position.  Any false statement or failure to disclose 
requested information will result in refusal of employ ment or, if employed, termination from employment. 
 If you have been charged with a violation of motor vehicle laws/ordinances  other than parking violations and you are awaiting a trial or other 
disposition, indicate the off ense charged and the expected date of trial or other  disposition, except as noted below.  If you are applying for a job in 
California, Massachusetts or Rhode Island,  see section on preceding page under Criminal  Records for traffic offenses which you do not need to 
disclose.  You do not have to report any offenses for which y ou have been arrested or charged, but that did not result in a con viction.	
 List all 
violations of motor vehicle laws/ordinanc es for which you have attended Traffic School where the charge has not been removed fr om your driving 
record.  If 	
you are unsure	, you should list the violation. 	
List all Violations here (If you have no violations, state “none” in box 1) 	1 	mm/yyyy 	4 	mm/yyyy 	
      	      	      	      	
2 	mm/yyyy 	5 	mm/yyyy 	
      	      	      	      	
3 	mm/yyyy 	6 	mm/yyyy 	
      	      	      	      	
List any accidents within the past 3 years.  Specify the date and nature of the accident (head-on, rear-end, etc.) and any fatalities or personal injuries caused.  List by 
date of occurrence starting with the most recent. 
       
Do 	you hold a valid driver’s license? 	License Numbe	r	Issuin	g State 	
  Yes     	  No 	      	      	
Have you ever held a commercial driver’s license? 	License Number(s) 	Issuing State 	
  Yes     	  No 	      	      	
Within the past 3 years, have you held a commercial driving position?               	  Yes     	  No 	
Indicate the nature/extent of your experi ence in the operation of motor vehicles, including class and type of equipment (i.e.,  vans, buses, trucks, truck tractors, semi-
trailers, full trailers and pole trailers). Include the length  of time (start and end date) for each type of equipment. 
       
Have you held a driver’s license in any other State during the past 3 years?               	  Yes     	  No 	
License Number 	Issuing State 	
      	      	
Have you 	ever	 had a license, permit or privilege to operate a motor vehicle denied, revoked or suspended?            	  Yes     	  No 	
List all Suspensions here (If you have no suspensions, state “none” in box 1) 	1 	mm/yyyy 	4 	mm/yyyy 	
      	      	      	      	
2 	mm/yyyy 	5 	mm/yyyy 	
      	      	      	      	
3 	mm/yyyy 	6 	mm/yyyy

6 
Name 	 	Social Security Number 	
      	 	      	 
UNDERSTANDING AND AGREEMENT 
 
This application, any handbooks, policies, pr actices, procedures and other communications do not individually or collectively constitute a contract of 
employment or a guarantee of employment for any specific term .  Subject to any applicable collective bargaining agreement or ap plicable law, (a) 
my employment is “at will,” which means that any offer of employ ment if made to me, or employment of me can be terminated at an y time by my 
employer or by me with or without cause or prior notice, (b ) compensation, benefits, policies, practices, procedures and terms and conditions of 
employment, with the exception of my “at will” status, may be chan ged or eliminated by my employer at any time without notice, and (c) I will comply 
with the rules and regulations of my employer, if I am hired.   This paragraph supersedes any and all prior representations (exp ress or implied) to the 
contrary with respect to the grounds for which, and the manner  by which, my employment with Verizon can be terminated. 
 Verizon Companies or their agents may conduct investigations, including, but not limited to, those relating to prior employment  history, record or 
conviction, pending trial status, and driving re cord, as permitted by law.  An investigative consumer report including informat ion as to my character 
and personal characteristics may be made and  I have the right to request (in writing) whether a report is sought, the name and  address of the 
investigating consumer reporting agency and a complete and accurate  disclosure of the nature and scope of the investigation.  If a Consumer 
Reporting Agency is engaged in this investigation, information re levant to the nature and scope of the inquiry, if one is made, will be provided to me 
if adverse action concerning my employment is  taken based, wholly or in part, on this investigation.  Information that I have p rovided on this 
application, on my resume, or any other document provided to Ve rizon Communications as part of the application process is true and correct.  	
By 	signing this application below, I authorize Verizon Communications Companies and their agents to conduct this investigation and  I indicate my awareness that any false or misleading statement or failure to disclose requested information may result in refusal of employment or, in the event I am employed, may result in my immediate dismissal.	 	 If an offer of employment is made to me, it is conditioned on:  (a) the satisfactory completion of a medical evaluation (when required by the job 
opening) conducted by a clinic approved by Verizon; (b) my ab ility to produce documentation establishing both my identity and e mployment 
authorization as required by law, and my completion of the employ ment verification form designated by the Immigration and Naturalization Service;  
(c) the results of a urinalysis screening for both legal and illegal  drugs;  (d) my successful completion of any other requirements mandated under 
federal, state or local laws; and (e) my meeting  the minimum age requirement of applicable law. 
 If I am employed, I will protect private or proprietary information owned or controlled by Veriz on.  If required, as a condition of my employment, I will 
sign the “Employment Agreement Regarding Intellectual Property and Proprietary Information” which assigns to the Company certai n inventions, 
discoveries, improvements, ideas, computer or other apparatus,  programs of work of authorship.  If I have signed any agreements  with any previous 
and/or current employers, relating to intellectual property (s uch as confidentiality proprietary rights, non-compete agreements, non-solicitation of 
customers agreements, etc.)  I will provide a copy of any such  agreements with this application.  I warrant and represent that  copies of any such 
agreements are provided with this application  for employment.  To the extent I do not have copies of such agreement(s), I have  submitted with this 
application a written statement that describes the terms of such agreement(s). 
 In the event I am employed, my eligibility for a pension will be based on the requirements set forth in the applicable pension  plan if any, the 
provisions of which will be described in a summary plan de scription to be supplied to me following my employment. 
 No oral representation of any Company employee or agent can alter any of the above five paragraphs.  If hired, I understand and acknowledge that my employer will be t he individual and specific Verizon operating company, affiliate subsidiary, or 
successor company to which I report on a regular  basis as a full or part-time employee.  This application will remain in effect  during my term of 
employment with Verizon and any of its operating compani es, affiliates, subsidiaries or successor companies. 
 Have you ever been employed by a firm that performed Public  Service Commission mandated audits of New York Telephone, NYNEX, or any other 
NYNEX subsidiary or by any subsidiary or aff iliate which performed any such audit?      	  Yes     	  No   (if yes, please explain) 	
      
  This certifies that this application was  completed by me, and that all entries are 
true and complete to the best of my knowledge.  	
 	
 Under Maryland law, an employer may not require or demand, as a 
condition of employment, prospective employment, or continued 
employment, that an individual  submit to or take a lie detector or similar test.  
An employer who violates this law is guilty of a misdemeanor and subject to 
a fine not exceeding $100. 	
 	      	 	      	 	 	 	      	 	      	 	
 	Signature of Applicant 	 	Date 	 	 	 	Signature of Applicant 	 	Date

Application Date (mm/dd/yyyy) 	 	Social Security Number 	
      	 	      	
 
   7 
VOLUNTARY SELF-ID  	
 	
 Verizon, as a federal contractor, is required to maintain s pecific information on applicants for governmental reporting purpose s.  Any information 
provided is confidential and will be used for the Company’s Affirmat ive Action efforts.  The submission of this information is voluntary and will not 
subject you to any adverse treatment.  However, if you choose  not to “self-identify,” we are required under Federal law to maintain race and gender 
information on the basis of visual observa tion and personal knowledge.  If you do not wish  to furnish this information, please initial below. 
 	I do not wish to furnish this information. 	           	(Initials) 	
 
Gender: 	Race/Ethnic Group 	(see definitions below):	 	
 	 	  Male 	  White 	
  Female 	  Black or African American 	 	 	
  Hispanic or Latino  	 	 	 	
  Asian  	 	 	 	  American Indian or Alaska Native 
  Native Hawaiian or Other Pacific Islander 
  Two or More Races 	 	 	 	
  Unknown 	 	 	 	      	 	
 	 	
 	 	
 White (Not Hispanic or Latino) -  A person having origins in any of the original peopl es of Europe, the Middle East, or North Africa.  
 
Black or African American (Not Hispanic or Latino) -  A person having origins in any of the black racial groups of Africa.  
 
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central Amer ican, or other Spanish culture or origin regardless of race. 
 
Asian (Not Hispanic or Latino) - A person having origins in any of the peoples of the  Far East, Southeast Asia, or the Indian Subcontinent, 
including, for example, Cambodia, China, India, Japan, Korea,  Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam . 
 
American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the peoples of North and South America (including 
Central America), and who maintain tribal affiliation or community attachment.  
 
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)  - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or 
other Pacific Islands. 
 
Two or More Races (Not Hispanic or Latino) -  All persons who identify with more than one of the above six races.
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