H&S Employment Application

Name*

First Last

Email*

Document Upload*

Accepted file types: jpg, doc, docx, pdf, jpg, Max. file size: 20 MB.

Upload your resume and additional employment history in MS-Word, PDF, of JPG format.

Hidden

Document Upload

Drop files here or

Accepted file types: jpg, doc, docx, pdf, jpg, Max. file size: 20 MB, Max. files: 10.

Upload your resume and additional employment history in MS-Word, PDF, of JPG format.

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Phone (Alternative)

Are you 18 years of age or older?*

Yes
No

Do you read and speak English?*

Yes
No

Driver's License Information

If no driver's license, need to show State ID

Driver's License Number*

State Identification Number

Untitled*

Application Information

If required, would you be willing to: (check all that apply)

Work Overtime
Shiftwork
Work Holidays
Work Weekends
Relocate

Have you ever been convicted of a felony within the last three years?*

Yes
No

(Convictions include fine, jail term, probation, or suspended sentence.)

Within the last three years, have you been held guilty of any offense, of driving while under the influence of alcohol or drugs?*

Yes
No

(Include all offenses resulting in anything other than acquittal of dismissal of charges (i.e., conviction, fine, license suspension or revocation, jail term, probation, suspended sentence and community service)

Have the essential functions of the job for which you are applying been explained to you?*

Yes
No

Are you able to perform these tasks without an accommodation?*

Yes
No

(Any reasonable "accommodation" is a change to the work area that allows a qualified person with a disability to perform the work required)

Employment History

Account for all 36 months, including periods of unemployment. Start with your current or most recent position. List name and address of 3 previous employers with position held, dates held, and reason for leaving. Describe the work performed and previous rate of pay.*

*No application will be considered without complete work history.

I understand and agree that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the Employer's service if I have been employed. I authorize the Employer to investigate all references and to secure additional information about me, if job related. I hereby release the Employer and its representatives from liability for seeking such information, and release all other persons, corporations or organizations from liability for furnishing such information.

Signature of Applicant*

Date*

CAPTCHA