Employment Application

Date of Application: *

Where are you interested in working? *

What position are you interested in? *

PERSONAL INFORMATION

First Name *

Middle Name

Last Name *

Address *

Address

Present Street Name & Number

Address

City

State/Province

Zip/Postal

Home Phone

Mobile Phone

Email *

Social Security Number *

Name and phone number of person to be notified in case of emergency (including area code)

DO YOU HAVE ANY PHYSICAL OR MENTAL CONDITION THAT PREVENTS YOU FROM PERFORMING THE ESSENTIAL FUNCTIONS OF THE POSITION FOR WHICH YOU ARE APPLYING? *

YES

IF YES, PLEASE EXPLAIN BELOW: *

CAN YOU, AFTER AN OFFER OF EMPLOYMENT IS MADE, SUBMIT VERIFICATION OF YOUR LEGAL RIGHT TO WORK IN THE U.S.? (PROOF OF IDENTITY AND LEGAL AUTHORITY IN THE U.S. MAY BE REQUIRED AFTER AN OFFER OF EMPLOYMENT IS MADE) *

YES

ARE YOU AT LEAST AGE 21? (PROOF OF AGE AND WORK PERMITS MAY BE REQUIRED PRIOR TO HIRING) *

YES

(CA and Austin TX Applicants DO NOT Answer The Next Two Questions About Criminal Background)

HAVE YOU EVER BEEN CONVICTED OF A CRIME? *

YES

IF YES, PLEASE EXPLAIN BELOW: *

HAVE YOU EVER BEEN CONVICTED BY A COURT, INCLUDING MILITARY COURT, OF A FELONY OR MISDEMEANOR, OR RECEIVED DEFERRED ADJUDICATION UNDER YOUR PRESENT NAME OR ANY OTHER? *

YES

IF YES, PLEASE EXPLAIN BELOW: *

DO YOU HAVE A RELIABLE MEANS OF TRANSPORTATION TO AND FROM WORK? *

YES

HAVE YOU EVER BEEN DENIED A DRIVER'S LICENSE, PERMIT OR PRIVILEGE TO OPERATE A MOTOR VEHICLE? *

YES

IF YES, PLEASE EXPLAIN BELOW: *

HAVE YOU EVER BEEN CONVICTED OF DRIVING UNDER THE INFLUENCE OF ALCOHOL OR DRUGS? *

YES

IF YES, PLEASE EXPLAIN BELOW: *

HAVE YOU EVER BEEN REFUSED AUTO LIABILITY INSURANCE? *

YES

IF YES, PLEASE EXPLAIN BELOW: *

HAVE YOU EVER BEEN INVOLVED IN ANY AUTOMOBILE ACCIDENTS IN THE PAST THREE YEARS? *

YES

IF YES, PLEASE EXPLAIN BELOW: *

HAVE YOU EVER BEEN DISMISSED OR FORCED TO RESIGN FROM ANY EMPLOYMENT? *

YES

IF YES, PLEASE EXPLAIN BELOW: *

IN ORDER TO PERFORM A BACKGROUND CHECK OF YOUR EMPLOYMENT, EDUCATION, DRIVER'S LICENSE AND CRIMINAL RECORDS, PLEASE INDICATE IF YOU HAVE EVER BEEN KNOWN BY ANOTHER NAME *

YES

IF YES, PLEASE LIST ALL NAME(S) USED BELOW *

NUMBER OF TRAFFIC VIOLATIONS IN THE LAST THREE YEARS? *

EDUCATION

HIGH SCHOOL

Graduate Highschool?

Yes

Number of years?

Major course of study?

COLLEGE

Graduate College?

Yes

Number of years?

Major course of study?

TRADE SCHOOL

Graduate?

Yes

Number of years?

Major course of study?

OTHER

Graduate?

Yes

Number of years?

Major course of study?

EXTRACURRICULAR ACTIVITIES AND/OR HOBBIES

GENERAL INFORMATION

Date available to start?

Interested In?

Fulltime

Partime

What foreign languages do you speak fluently?

Read?

Write?

What interested you in Hands of Healing?

How did you hear about Hands of Healing?

EMPLOYMENT / WORK EXPERIENCE

Company 1

NAME OF COMPANY AND/OR ORGANIZATION

TELEPHONE

ADDRESS

ADDRESS (Street Name & Number)

ADDRESS

CITY

STATE

ZIP

First Day Worked

Last Day Worked

RATE OF PAY (starting & ending)

HOURS WORKED PER WEEK

POSITION(S) HELD

SUPERVISOR'S NAME & POSITION

DESCRIBE YOUR DUTIES

MAY WE CONTACT THIS EMPLOYER?

YES

REASON FOR LEAVING

NAME OF COMPANY AND/OR ORGANIZATION

TELEPHONE

ADDRESS

FIRST DAY WORKED

LAST DAY WORKED

RATE OF PAY (starting & ending)

HOURS WORKED PER WEEK

POSITION(S) HELD

SUPERVISOR'S NAME & POSITION

DESCRIBE YOUR DUTIES

MAY WE CONTACT THIS EMPLOYER?

YES

REASON FOR LEAVING

NAME OF COMPANY AND/OR ORGANIZATION

TELEPHONE

ADDRESS

FIRST DAY WORKED

LAST DAY WORKED

RATE OF PAY (starting & ending)

HOURS WORKED PER WEEK

POSITION(S) HELD

SUPERVISOR'S NAME & POSITION

DESCRIBE YOUR DUTIES

MAY WE CONTACT THIS EMPLOYER?

YES

REASONS FOR LEAVING

NAME OF COMPANY AND/OR ORGANIZATION

TELEPHONE

ADDRESS

FIRST DAY WORKED

LAST DAY WORKED

RATE OF PAY (starting & ending)

HOURS WORKED PER WEEK

POSITION(S) HELD

SUPERVISOR'S NAME & POSITION

DESCRIBE YOUR DUTIES

MAY WE CONTACT THIS EMPLOYER?

YES

REASON FOR LEAVING

RESUME & SIGNATURE

Attach Resume

Maximum file size: 134.22MB

SIGNATURE OF APPLICANT

Clear

DATE

If you are human, leave this field blank.

PERSONAL INFORMATION

EDUCATION

GENERAL INFORMATION

EMPLOYMENT / WORK EXPERIENCE

RESUME & SIGNATURE

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