If you are human, leave this field blank. ONLINE APPLICATION
Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.
Position(s) Applied For *
Date of Application *
Last Name *
First Name *
Last 4 of SSN *
Zip Code *
Phone # *
E-mail Address *
Referral Source (How did you hear about us?) *
If you are under 18, and it is required, can you furnish a work permit?
If no, please explain:
Are you legally eligible for employment in this country?
Date available for work *
Desired Salary Minimum *
Desired Salary Maximum *
Have you ever been employed by HRI before?
If yes, give dates and positions:
Type of employment desired:
Driver's License Number (If driving may be required in position for which you are applying)
Driver's License State
Answering “yes” to the following question 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 considered.
Have you ever pled “guilty” or “no contest” to, or been convicted of a crime?
If yes, please provide date(s) and details:
This job may require weekend, overtime, holiday, and out of town work. Would you be available for these work requirements?
If no, please explain: EMPLOYMENT HISTORY
Starting with your most recent employer, provide the following information:
SKILLS AND QUALIFICATIONS
Summarize any special training, skills, licenses and/or certifications that may assist you in performing the position for which you are applying: * EDUCATIONAL BACKGROUND
Starting with your most recent school attended, provide the following information:
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.
SIGN AND SUBMIT APPLICATION
I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize, without reservations, 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 truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 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 for me to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or 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 express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. 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 eliminate me from further consideration for employment, or may result in my immediate discharge from the employer's service, whenever it is discovered.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.
Signature of Applicant *