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Employment Application

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.
Current Address
Street:
City:
State:
Zip Code:
Undergrad School
School:
City:
State:
Diploma:
Deg/Cert/Dip:
Area of Study:
Grad School
School:
City:
State
Diploma:
Deg/Cert/Dip:
Area of Study:
Other School
School:
City:
State:
Diploma:
Deg/Cert/Dip:
Area of Study:
Employment Information
Position Applied For:
Date You Can Start:
Desired Salary ($):
Do You Prefer:
Can you work:
 
Weekends
 
Evenings
Available:
 
M
 
Tu
 
W
 
Th
 
F
 
Sa
 
Su
Not Available:
Please answer all of the following questions.
1.
Are you at least 18 years of age and legally eligible to work for our company in the United States?
2.
Have you worked for this business before?
 
If yes, please provide dates and locations.
 
3.
Have you received a description of the job or been made aware of the essential functions of the job for which you are applying?
4.
Do you understand the job requirements?
 
If no, please explain.
 
5.
Are you on layoff and subject to recall?
6.
Are you currently bound by a noncompetition, confidentiality or trade secret agreement?
 
If yes, please explain...
 
7.
Have you ever been discharged or asked to resign from a job?
 
If yes, please explain...
 
8.
Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?
 
If yes, please explain...
 
Employer
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (1)
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (2)
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (3)
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Job-related Skills
4.
Please list all states from which you hold or held a driver's license:
 
Resume (Text Version)
 
Copy and Paste a text version of your resume here.
 
Upload File
 
Attach a file to your application submission
 
Employee Acknowledgement and Release
1.
I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE, I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT.
2.
I hereby authorize H2M Labs, Inc. and any other affiliates operating under H2M Group to contact any and all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county and federal courts, military services to release information about my background including, but not limited to, information about employment, education, consumer credit history, driving record, criminal record and general public records history to H2M Labs, Inc. and any other affiliates operating under H2M Group.
3.
I release from all liability all persons, companies, schools supplying such information. I indemnify H2M Labs, Inc. and any other affiliates operating under H2M Group against any liability, which may result from making such requests. This release shall remain in effect for the length of my employment. I understand and I may have a right to request additional disclosures regarding the nature and scope of the investigation. I fully understand the terms of this release.
4.
I understand that employment at H2M is deemed to be "an employment at will." H2M or I may terminate my employment at any time at the sole and irrevocable discretion of either party.
5.
By typing my name in the box below, I am electronically signing this employment application and agreeing to the “Employee Acknowledgement & Release” as stated above.
 
Signature
 
Type Name in Signature Box:
 
 
Today's Date: 2010-09-07 17:13:39 PDT

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