INSTRUCTIONS: This form must be completed by any candidate aged 18 years & older being considered for employment, internship, volunteer work or contracted services with Wisconsin State Fair Park (WSFP). Provision of Sex, Race and Social Security Number is not required but may impact whether a thorough background check may be completed and thus, employment offered or denied. Failure to complete this form will remove you from consideration for the position.

The Wisconsin Fair Employment Act prohibits employment discrimination based on arrest and conviction records or pending charges. However, it is not discrimination to not offer employment to an individual if that individual’s pending charge(s) or conviction(s) are substantially related to the job.

POSITION INFORMATION – COMPLETED BY HIRING SUPERVISOR & ALL FIELDS MUST BE COMPLETED
POSITION TYPE
Employee (Permanent or LTE) Unpaid Intern Volunteer Contractor
POSITION APPLIED FOR	POSITION #	DEPARTMENT (Admissions, Grounds, Public Safety, etc.)
HIRING SUPERVISOR/LEAD WORKER	LOCATION OF WORK (Expo, WPP, Barns, Bus Ofc, Grandstand, etc.)

APPLICANT INFORMATION – PLEASE PRINT LEGIBLY AS ILLEGIBLE FORMS MAY NOT BE PROCESSED OR MAY BE DELAYED
CHECK HERE IF YOU ARE A CURRENT EMPLOYEE OF WISCONSIN STATE FAIR PARK
LEGAL NAME – Last, First, Middle (Please Print)	MAIDEN/ALIAS/FORMER NAMES (Please Print)
SEX	RACE	DATE OF BIRTH*	SOCIAL SECURITY NUMBER
Male Female	1. Black (not Hispanic) 2. Asian or Pacific Islander 3. American Indian or Alaskan Native	4. Hispanic 5. White (not Hispanic)
*NOTE: Background checks are not conducted on minors under 18 years old & this form should not be completed
STREET ADDRESS (NO PO BOXES)	CITY	STATE	ZIP CODE

RESIDENCE INFORMATION List all residences where you've lived in the prior five (5) years, not including above, with most recent first. Attach pages if needed.
BEGIN DATE	END DATE	STREET ADDRESS (NO PO BOXES)	CITY	STATE

DISCLOSURE INFORMATION: If you would like to disclose any information regarding your criminal background, including past or pending criminal violations, that you feel may impact your eligibility for employment, please contact Human Resources at HR@wistatefair.com or 414.266.7016 to complete a Criminal Background Violation Disclosure Form.

Certification: I certify that the above information is true and accurate to the best of my knowledge and that any falsification or omission of information may disqualify me from consideration. I authorize WSFP to conduct a background check and verify the information provided above. I understand that this form may be used as authorization for any subsequent background checks required and that it is my responsibility to inform Human Resources within one (1) business day if anything in my background changes.

SIGNATURE	DATE SIGNED