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Company*

First Name*

Last Name*

Email*

Phone*

Number of Employees

Comments/Questions

Application for Employment

Want to send your resume to HBR Technologies? Click here and include your resume as an attachment.

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodations to the application and/or interview process should notify a representative of the Human Resource Department.

*Denotes required information or section.

Name*:
Email*:
 
Position(s) applied for*:
 
Referral Source:
Advertisement Private Employment Agency
Relative Government Employment Agency
Employee Other
Name of source
(if applicable):
 
Address*:
City*:
State*: Zip*:
 
Phone*:
Other phone:
If necessary, what is the best time to call you at home?*
 
May we contact you at work? Yes No
If yes, work number and best time to call:
 
If you are under 18 and it is required, can you furnish a work permit? Yes No
If no, please explain:
 
Have you submitted an application here before? Yes No
If yes, give date(s) and position(s):
 
Have you ever been employed here before? Yes No
If yes, give dates:
 
Are you legally eligible for employment in this country? Yes No
 
Date available for work*:
 
What is your desired salary range?*
 
Will you relocate if job requires it? Yes No
 
Will you travel if job requires it? Yes No
 
Are you able to meet the attendance requirements of the position? Yes No
 
Will you work overtime if required? Yes No
If no, please explain:
 
Have you ever been bonded? Yes No
Have you ever pled "guilty" or "no contest" to, or been convicted of, a crime? Yes No
If yes, please provide date(s) and details:
 
Answering "yes" to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Type of employment desired:
Full–time Part–Time
Temporary Seasonal
Educational Co–Op
 
Driver´s license number if driving is an essential job function:
State:
 

Employment History*

Provide the following information of your past and current employers, assignments or volunteer activities, starting with the most recent. Explain any gaps in employment in comments section below.

Employer: Starting/Final
Job Title:
Phone: Immediate Supervisor & Title:
Address: Reason for Leaving:
May we contact for reference? Yes No Later
Date Employed Summarize the type of work performed and job responsibilities
From To
Hourly Rate/Salary (Starting)
$ Per
Hourly Rate/Salary (Final)
$ Per

 

Employer: Starting/Final
Job Title:
Phone: Immediate Supervisor & Title:
Address: Reason for Leaving:
May we contact for reference? Yes No Later
Date Employed Summarize the type of work performed and job responsibilities
From To
Hourly Rate/Salary (Starting)
$ Per
Hourly Rate/Salary (Final)
$ Per

 

Employer: Starting/Final
Job Title:
Phone: Immediate Supervisor & Title:
Address: Reason for Leaving:
May we contact for reference? Yes No Later
Date Employed Summarize the type of work performed and job responsibilities
From To
Hourly Rate/Salary (Starting)
$ Per
Hourly Rate/Salary (Final)
$ Per

 

Employer: Starting/Final
Job Title:
Phone: Immediate Supervisor & Title:
Address: Reason for Leaving:
May we contact for reference? Yes No Later
Date Employed Summarize the type of work performed and job responsibilities
From To
Hourly Rate/Salary (Starting)
$ Per
Hourly Rate/Salary (Final)
$ Per

Comments including explanation on any gaps in employment:

 

Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job–related functions in the position for which you are applying.

 

Educational Background (if job related)

A. List last three (3) schools attended, starting with most recent. B. List number of years completed. C. Grade Point Average or Class Rank. D. Indicate degree or diploma earned, if any. E. Major field of study. F. Minor field of study (if applicable).

A. School B. Yrs. Completed
C. GPA / Rank		 D. Degree /
Diploma		 E. Major
F. Minor

 

References*

List name and telephone number of three business/work references who are not related to you and are not previous supervisors.

If not applicable, list three school or personal references who are not related to you.

Name Telephone Number of Years Known

 

Additional Information

List professional, trade, business or civic associations and any offices held.

Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.

Organization Offices Held

List special accomplishments, publications, awards, etc.
Exclude membership that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.

List any additional information you would like us to consider.

 

Applicant Statement*

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume´ or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out and new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing e´’s president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I–9 Form in this regard.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

Upon checking "I Agree" I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

I Agree      Date:

Clicking on Submit will send your application to the HBR Technologies
Human Resources Department.