HMR Application for Employment -

HMR Application for Employment

Position You Are Applying For: *

Desired Salary: *

Date Available For Work: *

Name *

First

Middle

Last

Address: *

City/State/Zip Code *

Home/Cell Phone Number *

Are You A U.S. Citizen? *

Email *

Social Security Number: *

If Selected For Employment, Are You Willing To Submit To A Pre-Employment Drug Screening Test? *

Have You Ever Been Convicted Of A Felony? *

Education *

Please List All School Names, Locations, Years Attended, Degree(s) Received, and Major(s)

Training/Certifications/Licenses *

Please List All Trainings, Certifications, and Licenses Held

Employer Name *

Dates Employed: *

Work Phone: *

Pay Rate $: *

Hourly or Salary

Address *

Employer Address

City/State/Zip Code *

Position: *

Duties Performed: *

Supervisor’s Name & Title: *

Reason For Leaving: *

May We Contact Them?: *

References *

Please List 3 References. Each By Name, Title, Company, and Phone Number

Acknowledgement & Authorization *

I certify that all answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.

Please Acknowledge & Check All Boxes

Applicant Signature: *

By Typing Your Name, You Are Agreeing To The Signing Of This Application.

Date: *

Today’s Date