Application for Employment

HR Associates Personnel Service is an Equal Opportunity Educational Institution and EEO/Affirmative Action Employer committed to excellence through diversity. Employment offers are made on the basis of qualifications and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.

PLEASE PRINT Complete the entire application. You may attach a resume, but you must still complete all questions; or your application will be deemed incomplete and may not be considered. Please fill out each box (Don’t just indicate “See Resume”) Applications with missing or invalid job numbers will not be considered for any position.

Position Applying For:

 

Name  (Last, First, Middle):

Other names under which you have attended school or been employed:

Street Address:

City, State & Zip:

Social Security Number:

Home Phone:

               

Emergency Phone:

Other Phone:

Are you eligible to work in the United States?

☐Yes     ☐No

Are you 18 years of age or older?

☐ Yes    ☐ No

If NO,   what is your current age?

Date you are available?

1st            8hrs

2nd          10hrs

3rd           12hrs

Available days you can work:

Mon, Tues, Wed, Thurs, Fri, Sat, Sun

Have you ever been convicted of a crime?

☐ Yes   ☐No

If YES, please explain:

Are you related to any current (employee)?

☐Yes    ☐ No

If YES, their name & their relationship to you?

Do you have your own transportation?

☐ Yes   ☐ No

Driver’s License # and expiration date:

How did you hear about this employment opportunity with HR Associates?   Check all that apply:    

☐ Job Bulletin (Posting)  ☐Walk-in   ☐ Website       ☐ Dept. of Labor    ☐ Referral by employee  ☐Other:  

        EDUCATION

Name of School

City/State

Did you graduate?

If No, # of years left to graduate

If Yes,  date of Graduation

Degree received

Major

High School:

☐Yes   ☐ No

GED:

☐Yes   ☐ No

Other School:

☐Yes   ☐ No

College:

☐Yes   ☐ No

Other credentials/ licenses/ professional affiliations, etc., which are relevant to the job(s) for which you are applying.

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SKILLS:  Please list technical skills, clerical skills, trade skills, etc., relevant to this position.  Include relevant computer systems and  software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert)

                                                                                                                                       

                                                                                                                                     Pg. 1 of 2

WORK EXPERIENCE-Please detail your entire work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately.  Omission of prior employment may be considered falsification of information. Please explain any gaps in employment.  PLEASE DO NOT complete this information with the notation “See Resume.” PLEASE NOTE: HR Associates Personnel Service reserves the right to contact all current and former employers for reference information.

                

Dates Employed (most recent position)

From:          To:

         

☐Full time     ☐   Part-time

If part-time, # hrs./wk:

Title:

Starting Salary:

Organization Name and Address:

Final Salary:

Supervisor’s Name, Title and Phone  #:

Other Reference Name, Title and Phone #:

May we contact your previous employer? ☐ YES   ☐ NO

Primary duties:

Reason for Leaving:

Dates Employed (most recent position)

From:          To:

☐Full time     ☐   Part-time

If part-time, # hrs./wk: ☐

Title:

Starting Salary:

Organization Name and Address:

Final Salary:

Supervisor’s Name, Title and Phone  #:

Other Reference Name, Title and Phone #:

May we contact your previous employer? ☐ YES   ☐ NO

Primary duties:

Reason for Leaving:

Dates Employed (most recent position)

From:          To:

         

☐Full time     ☐   Part-time

If part-time, # hrs./wk: ☐

Title:

Starting Salary:

Organization Name and Address:

Final Salary:

Supervisor’s Name, Title and Phone  #:

Other Reference Name, Title and Phone #:

May we contact your previous employer? ☐ YES   ☐ NO

Primary duties:

Reason for Leaving:

 PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION                                                                                                                       I certify that the information on this application and its supporting documents is accurate and complete.  I understand and agree that failure to fully complete the form, or                            misrepresentation or omission of facts represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date.                                          I authorize HR Associates Personnel Service to investigate, without liability, all statements contained in this application and supporting materials.  I authorize references                                       and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a                                       physical exam, criminal background investigation, and/or screening for illegal substances upon conditional offer of employment.  I understand that this document is

NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment.  I understand that staff

employees of HR Associates Personnel Service serve at-will, and the employment relationship may be terminated at any time by HR Associates Personnel Service, or any                                         or no reason,  other than a reason prohibited by law

Applicant Signature: _________________________                                        Date: ____________                                                                                                                                                                      Pg. 2 of 2