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APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

Full Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Home Phone #:

Mobile Phone #

Are you eligible to work in the U.S?*

Yes
No

Are you at least 21 years or older? (If no, you may be required to provide authorization to work.)*

Yes
No

Have you ever worked for this company?*

Yes
No

Have you ever been convicted of a felony?*

Yes
No

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?*

Yes
No

EMPLOYMENT DESIRED

Date you can start

Hourly Rate / Salary desired

Position Desired

Are you currently employed?*

Yes
No

If so may we inquire of your present employer?*

Yes
No

REFERRAL SOURCE

How did you hear about us?

Walk in
Advertisement
Referal
Other

Do you know anyone who works for our company*

Yes
No

If yes, who?

EDUCATION

Highschool

Name and location of school

No. of yrs. Attended

Degree Received

Subjects Studied/Major

College or University

Name and location of school

No. of yrs. Attended

Degree Received

Subjects Studied/Major

Trade, Business or Correspondence School

Name and location of school

No. of yrs. Attended

Degree Received

Subjects Studied/Major

EMPLOYMENT HISTORY

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

From:

To:

Employer Name

Phone

Job Title

Address

Immediate Supervisor and Title

Summarize the nature of work performed and job responsibilities

Reason for leaving

Hourly Rate / Salary

From:

To:

Employer Name

Phone

Job Title

Address

Immediate Supervisor and Title

Summarize the nature of work performed and job responsibilities

Reason for leaving

Hourly Rate / Salary

From:

To:

Employer Name

Phone

Job Title

Address

Immediate Supervisor and Title

Summarize the nature of work performed and job responsibilities

Reason for leaving

Hourly Rate / Salary

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain.

Computer Skills (please describe):

References

Give the names of three persons not related to you, whom you have known at least three (3) years. (use the + sign on the side to add additional references)

Name	Address	Phone	Email	Company	Years Acquainted

Please read carefully before signing.

The Harford Center is an equal opportunity employer. The Harford Center does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for The Harford Center to hire me. If I am hired, I understand that either [Company Name] or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of The Harford Center has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to The Harford Center true and complete information on this application. No requested information has been concealed. I authorize [Company Name] to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Signature

09/22/2023

Online Application

EMPLOYMENT DESIRED

REFERRAL SOURCE

EDUCATION

EMPLOYMENT HISTORY