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Employment
Employment Application Form
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Indicates required field
Name
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First
Last
Current Mailing Address
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City
State
Zip Code
Country
Permanent Mailing Address
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City
State
Zip Code
Country
Phone Number
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Email
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Are you 15 years of age or older?
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Yes
No
Position Desired (1st Choice)
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Position Desired (2nd Choice)
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Position Desired (3rd Choice)
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What date would you be able to start?
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Have you ever applied to HRC before?
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Yes
No
If yes, when?
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Have you ever plead guilty or "no contest" to or been convicted of a criminal offense?
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Yes
No
If yes, give dates and circumstances.
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List of education. (Ex. 2019 Holcomb High School Graduate, 2023 GCCC Graduate Associates Degree.)
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List of current special license(s), permit(s), certification(s), and/or credit hours (Ex. CPR, Lifeguard, 1st Aid).
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Former Employment (Present or most recent listed first).
Business Name
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Business Phone Number
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Business Address
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City
State
Zip Code
Country
Years of Employment & Reason for Leaving.
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Business Name
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Business Phone Number
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Business Address
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City
State
Zip Code
Country
Years of Employment & Reason for Leaving
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Business Name
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Business Phone Number
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Address
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City
State
Zip Code
Country
Years of Employment & Reason for Leaving
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Personal References (List 3 people you are not related to)
Name
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First
Last
Occupation
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Phone Number
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Address
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City
State
Zip Code
Country
Name
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First
Last
Occupation
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Phone Number
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Address
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City
State
Zip Code
Country
Name
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First
Last
Occupation
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Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
If applying for a full-time or maintenance position, please fill out the following. (Listing your Driver's License # gives HRC your permission to run a MVR Report.)
Driver's License # and State issued in
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Employment Application Form Certification and Authorization
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authorization to enter into any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative."
By clicking "Yes" you are agreeing to and with the aforementioned statements.
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Yes
No
Submit
