Application

Application for Employment

PRE-EMPLOYMENT QUESTIONNAIRE EQUAL OPPORTUNITY EMPLOYER
  • Personal Information

  • General Information

    (Note: Conviction will not necessarily disqualify applicant)
  • Employment History

  • Employer name and address:Position title/duties, skills:Starting Pay:Ending Pay:Supervisor:Phone#:Start Date:End Date:Reason for leaving: 
  • Skills and Qualifications

  • Education

  • High School:LocationFromToDid you graduate?Degree
  • College:LocationFromToDid you graduate?Degree
  • Other:LocationFromToDid you graduate?Degree
  • Military Service

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • References

    List three personal references who are not related to you:
  • NameAddressPhoneOccupationYears Known 
  • Certification and Acknowledgement

    I certify that the information provided herein is true and correct to the best of my knowledge. I understand that, if employed, falsified statements on this Application for Employment form will be considered grounds for termination.

    I understand that I may be required to supply my birth certificate or other proof of authorization to work in the United States, consent to a drug test, and/or sign a conflict of interest agreement and abide by its terms.

    I authorize the company to thoroughly investigate my work experience and any other matters related to my suitability for employment. I further authorize my former employers to disclose to the company any and all information they may have concerning my previous employment. In addition, I hereby release Harper Special Services, my former employers, and all other persons from any and all claims, demands, or liabilities arising out of, or in any way related to such disclosure.

    I acknowledge that, if employed, both Harper Special Services and I have the right to terminate the employment relationship at any time, with or without cause or advance notice. This employment at will relationship will remain in effect throughout my employment with Harper Special Services and may not be modified by any oral implied agreement.

  • This field is for validation purposes and should be left unchanged.
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