Human Resources Application

HR Application

PERSONAL / CONTACT INFORMATION
Application Date:
Last 4 digits of SSN:
First name:
Last name:
Address:
City:
State:
Zip:
Email:
Phone:
Cell Number:
Emergency number:
Emergency Contact Name:
Available date:
APPLICATION INFO:
Availability:
Select Education Level:
Birthday Day/ Month:
Minimum compensation requirement per hour for temporary positions:
How did you hear about us?:
Have you ever plead guilty or "no contest" to, or been convicted of, a misdemeanor or felony?:
If yes, explain:
Can you, after employment, submit verification of legal right to work in the U.S.?:
STAFFING COMPANIES
List staffing services/search firms you have worked with:

QUALIFICATIONS & EXPERIENCE
Please select all that apply. (Hold the control key to select more than one item in a group.)
Payroll Applications : Certifications: Business Size Experience: Compensation: Foreign Languages PC Software: Employee Info: Data Entry:	HRIS Applications HR Job Titles Held Benefits: Business Industries: Mac software:
EMPLOYMENT HISTORY Please list most recent employer first.
Company:
Address:
Phone #:
Your Title:
Dates Employed:
Dept:
Starting Salary:
Present (or ending) Salary:
Supervisor's Name & Title:
Duties:
Reason for Leaving:
Notes:
2nd Most Recent Employer
Company:
Address:
Phone#:
Your Title:
Dates Employed:
Dept:
Starting Salary:
Present (or ending) Salary:
Supervisor's Name & Title:
Duties:
Reason for Leaving:
Notes:
3rd Most Recent Employer
Company:
Address:
Phone#:
Your Title:
Dates Employed:
Dept:
Starting Salary:
Present (or ending) Salary:
Supervisor's Name & Title:
Duties:
Reason for Leaving:
Notes:
Please explain fully any gaps in your employment history:
May we contact your current employer:
If no, please explain:
Have you ever been terminated or asked to resign from any job?:
If yes, please explain:
Have you ever used another name?:
Reason for another name:
If hired, would you have adequate transportation to and from work?:
Are you able to perform the essential requirements of any position for which you are applying, either with or without reasonable accommodations?
What reasonable accommodations may be made to allow you to perform the essential functions of the position for which you are applying?
EDUCATION
Name of School:
City:
State:
Highest leve of education completed:
if other:
Major(s):

Name of School:
City:
State:
Highest level of education completed:
If other:
Major(s):

If you agree to the terms, please type "AGREE" here:

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