Apply Now Online Application Job Application APPLICATION FOR EMPLOYMENT An Equal Opportunity EmployerFull Name* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 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 DESIREDDate you can start MM slash DD slash YYYY Hourly Rate / Salary desired Position Desired Are you currently employed?* Yes No If so may we inquire of your present employer?* Yes No REFERRAL SOURCEHow did you hear about us? Walk in Advertisement Referal Other Do you know anyone who works for our company* Yes No If yes, who? EDUCATIONHighschoolName and location of school No. of yrs. Attended Degree Received Subjects Studied/Major College or UniversityName and location of school No. of yrs. Attended Degree Received Subjects Studied/Major Trade, Business or Correspondence SchoolName and location of school No. of yrs. Attended Degree Received Subjects Studied/Major EMPLOYMENT HISTORYInclude 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 PhoneJob Title Address Immediate Supervisor and Title Summarize the nature of work performed and job responsibilitiesReason for leaving Hourly Rate / Salary From: To: Employer Name PhoneJob Title Address Immediate Supervisor and Title Summarize the nature of work performed and job responsibilitiesReason for leaving Hourly Rate / Salary From: To: Employer Name PhoneJob Title Address Immediate Supervisor and Title Summarize the nature of work performed and job responsibilitiesReason 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):ReferencesGive 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)NameAddressPhoneEmailCompanyYears 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. Signature05/22/2022