Job application 7 Job Application First Name* Middle Name Last Name* Address* Apartment Number City / Town State / Zip Telephone*Alternate TelephoneSocial Security Number Email* In order to verify past employment, education, and other records indicated on this application, is additional information regarding a change of name, use of an assumed name, or nickname necessary? Yes No If Yes, please explainPosition(s) Applied For Minimum Hourly Rate/Salary Required* Have you ever worked for HBM before? Yes No All offers are subject to verification of the applicant's identity and employment authorization. You will need to submit such documents upon employment.Do you have the legal right to work and reside in the U.S.? Yes No Indicate work availability: Full TIme Part Time Temporary Indicate when you are available to work: Mornings Afternoons Evenings Overnights (3rd Shift) Weekdays Weekends How were you referred to HBM? Newspaper Electronic Advertising Employment Agency Relative / Friend HBM Employee Walk-In Other Date available to start work? MM slash DD slash YYYY HBM Employee (Indicate name to entitle them for referral bonus) Other SPECIAL SKILLS Summarize special skills and training acquired through employment and other experienceEMPLOYMENT EXPERIENCE Start with your present or last job. Please include any verifiable volunteer work you have performed1.Employer TelephoneAddress Employment Date (Start) MM slash DD slash YYYY mm/dd/yyEmployment Date (End) MM slash DD slash YYYY mm/dd/yyName of Supervisor Job Title Hours worked per week Reason for leaving May we contact this employer? Yes No Describe your work2.Employer TelephoneAddress Employment Date (Start) MM slash DD slash YYYY mm/dd/yyEmployment Date (End) MM slash DD slash YYYY mm/dd/yyName of Supervisor Job Title Hours worked per week Reason for leaving May we contact this employer? Yes No Describe your work3.Employer TelephoneAddress Employment Date (Start) MM slash DD slash YYYY mm/dd/yyEmployment Date (End) MM slash DD slash YYYY mm/dd/yyName of Supervisor Job Title Hours worked per week Reason for leaving May we contact this employer? Yes No Describe your workEDUCATION High SchoolName and location of school Course of study No. of years completed Did you graduate? Yes No Degree or Diploma College / UniversityName and location of school Course of study No. of years completed Did you graduate? Yes No Degree or Diploma Graduate or ProfessionalName and location of school Course of study No. of years completed Did you graduate? Yes No Degree or Diploma REFERENCES Give name, address and telephone number of three references who are not related to you and are not previous employers:1.Name TelephoneAddress 2.Name TelephoneAddress 3.Name TelephoneAddress Can you perform the functions of the job you are applying for, with or without reasonable accomodation? Yes No If No, please explainI authorize investigation of all statements contained in this application and discussion with any present and previous employers and references. I understand that misrepresentation or omission of facts is cause for dismissal. Furthermore, I understand that my employment is at will; the terms and conditions of my employment and compensation can be changed or terminated at any time, with or without cause, and with or without notice.I understand and acknowledge that no representative of HBM, other than the President, has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing. Such agreement must be in writing signed by me and the individual designated above to be binding.SignatureCAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Δ
