Full Job Application

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Cell Phone*

Enter phone number

Home Phone*

Enter phone number

Can you perform the functions of the position which you are applying for with or without reasonable accomodations?

Position of Interest

Have you previously been employed by HPC? If Yes, list position and year:

Are you a U.S. citizen? If No, enter Visa type

Are you a Veteran? If Yes, list military branch

Have you ever been convicted of a violation of the law? If Yes, explain:

Have you ever been terminated or given the choice to resign? If Yes, explain:

Are you currently on parole, probation, or have a criminal case or trial pending. If Yes, explain:

State names of any relatives employed with HPC and your relationship to them:

Are you applying for an internship/volunteer position? If Yes, list referring agency/institution:

Days and Hours available

Referred by an HPC2 employee? If Yes, Employee Name:

Other referral sources:

If under 18, do you have a valid work permit?

Are you interested in temporary/contractual work?

Date available to start work:

List your skills: (Foreign languages/level of fluency, Typing wpm, Microsoft Applications, Filing and/or other:

Drivers license Number, State, Class

Please list any special licenses, certificates, including ADP, CPR, and First Aid Certifications:

Write a brief statement explaining why you would like to work for HPC2:

Professional/Scholastic Honors:

Are you currently attending school?

High School Name, Major Area, Years Completed, did you graduate and Diploma/Degree received?

College Name, Major Area, Years Completed, did you graduate and Diploma/Degree received

Other/Special training/Graduate School Name, Major Area, Years Completed, did you graduate and Diploma/Degree received

Do we have permission to contact your current employer if you should reach the interview stage?

1st Professional/Employment References

2nd Professional/Employment References

3rd Professional/Employment References