Application for Employment

Application for Employment

Hound Ears Club, Inc. is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status.
PERSONAL:
Name *

First Name Middle Name Last Name
Date

Month Day Year
Date Date Picker Icon

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number
Email
example@example.com
Position Sought
Part Time Full Time
Date Available

Month Day Year
Date Date Picker Icon
Salary Desired
Are you over 18 years old?

Yes No
Are you legally eligible for employment in the United States?

Yes No

EDUCATION:

Please indicate education or training which you believe qualifies you for the position you are seeking.
High School Completed

Yes No

College and/or Vocational School

School(s)
Major
City/State	No. Years Completed
Degrees Earned	Country

Other Training or Degrees

School(s)
Course
City/State	Degree or Certificate Earned
Degrees Earned	Country

PROFESSIONAL LICENSE OR MEMBERSHIP:

Professional License

Type of License Held
State Name of License Number
City	State of License Number
License Expiration Date	Country

Other Professional Memberships
(You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status or any other protected status.)
This application for employment is good for 30 days only. Consideration for employment after 30 days requires a new application.

Have you ever been employed in any facility of Hound Ears Club, Inc.

Yes No
If so, please state facility name and location and dates of employment

During the last ten years, have you ever been convicted of a crime other than a minor traffic offense?

Yes No
If so, explain:
(A conviction will not necissarily automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.)

EMPLOYMENT

List most recent employer first, including U.S. Military Service.
May we contact your current employer?

Yes No
If any employment was under a different name, indicate name:
Employer
Address
Phone Number

Area Code Phone Number
Position
Dates of Employment
From Mo/Yr to Mo/Yr
Salary
Supervisor
Department
Duties
FT or PT
No. of Hrs
Reason for Leaving
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Position
Dates of Employment
From Mo/Yr to Mo/Yr
Salary
Supervisor
Department
Duties
FT or PT
No. of Hrs
Reason for Leaving

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Position
Dates of Employment
From Mo/Yr to Mo/Yr
Salary
Supervisor
Department
Duties
FT or PT
No. of Hrs
Reason for Leaving

Add Additional Employer
Employer
Address
Phone Number

Area Code Phone Number
Position
Dates of Employment
From Mo/Yr to Mo/Yr
Salary
Supervisor
Department
Duties
FT or PT
No. of Hrs
Reason for Leaving

PROFESSIONAL REFERENCES
Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number
Email
example@example.com
Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number
Email
example@example.com

APPLICANT'S CERTIFICATION AND AGREEMENT

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Hound Ears Club, Inc. to verify their accuracy and to obtain reference information on my work performance. I hereby release Hound Ears Club, Inc. from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.

I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal.

I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.
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