Today's Date
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MM
DD
YYYY
Name
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First Name
Last Name
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
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(###)
###
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Email
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Position Applying For
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Date Available
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MM
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What shifts are you available to work
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Select all that apply
Are you 18 years of age or older
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Are you legally eligible to work in the United States
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Proof of eligibility will be required upon offer of employment.
Have you ever been employed by Hozhoni before
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If yes, list date(s) of employment and position(s) held below.
Have you ever applied with Hozhoni before
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If yes, tell us when below.
List any relatives or people you know currently employed by, or receiving support from, Hozhoni*
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If hired, do you expect to be engaged in, or employed by, other companies outside of Hozhoni
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If yes, please explain below.
Have you ever been convicted of any crime
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If yes, state the final disposition of the case, the date, and where it occurred below. A conviction will not be an absolute bar to employment.
Last high school name and location
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High school last grade completed
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1. College, university, other school, location
From
MM
DD
YYYY
To
MM
DD
YYYY
Total credit hours completed
Curriculum
Major
2. College, university, other school name, locatio
To
MM
DD
YYYY
From
MM
DD
YYYY
Total credit hours completed
Curriculum
Major
3. College, university, other school name, location
To
MM
DD
YYYY
From
MM
DD
YYYY
Total credit hours completed
Curriculum
Major
List below any courses or workshops you have attended that relate to the job for which you are applying
1. Present or Last Employer
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Phone
*
(###)
###
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Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
To
MM
DD
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From
MM
DD
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Job Title
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Supervisor's Name
*
Duties
*
Reason for Leaving
*
2. Employer
Phone
(###)
###
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
To
MM
DD
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From
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DD
YYYY
Job Title
Supervisor's Name
Duties
Reason for Leaving
3. Employer
Phone
(###)
###
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
To
MM
DD
YYYY
From
MM
DD
YYYY
Job Title
Supervisor's Name
Duties
Reason for Leaving
4. Employer
Phone
(###)
###
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
To
MM
DD
YYYY
From
MM
DD
YYYY
Job Title
Supervisor's Name
Duties
Reason for Leaving
5. Employer
Phone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
To
MM
DD
YYYY
From
MM
DD
YYYY
Job Title
Supervisor's Name
Duties
Reason for Leaving
6. Employer
Phone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
To
MM
DD
YYYY
From
MM
DD
YYYY
Job Title
Supervisor's Name
Duties
Have you ever been suspended, fired, or asked to resign
*
If yes, please explain below.
Have you ever been convicted of, or pled guilty/no contest to, a driving offense as an adult, including DUI and reckless driving offenses (excluding minor traffic violations).
If yes, please explain below.
Have you had any accidents or received any moving violations during the past three years.
If yes, please explain below.
1. Name
*
Title/Occupation
*
How do you know this reference
*
Phone
*
(###)
###
####
Years known
*
2. Name
*
Title/Occupation
*
How do you know this reference
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Phone
*
(###)
###
####
Years known
*
3. Name
*
Title/Occupation
*
How do you know this reference
*
Phone
*
(###)
###
####
Years known
*
4. Name
*
Title/Occupation
*
How do you know this reference
*
Phone
*
(###)
###
####
Years known
*
5. Name
*
Title/Occupation
*
How do you know this reference
*
Phone
*
(###)
###
####
Years known
*
Use the area below for other information that you want us to know and consider.
We are firmly committed to providing equal employment opportunity to all qualified individuals, and consider applications for all positions without regard to race, color, religion, gender, national origin, age, marital or Veteran status, the presence of a non-job-related medical condition or disability, Vietnam Era Veteran, or any other legally protected status. The Company is required by the Equal Employment Opportunity Commission to collect and maintain the information requested below for EEO statistical reporting purposes. The information you provide will not be used in evaluating your application for employment; it is voluntary and will be kept confidential.
PLEASE COMPLETE IN FULL:
MM
DD
YYYY
POSITION APPLIED FOR:
*
Name
*
First Name
Last Name
Sex
*
ETHNIC GROUP
Please check one of the descriptions below corresponding to the ethnic group with which you most
identify.
VETERAN STATUS:
If you are a person with a disability, a list of essential job functions for the position you are applying for is available from our Human Resources Representative. Please review them and answer the following questions:
Are you able to perform these tasks
If an accommodation is needed, how would you perform the tasks and with what accommodation(s)?
How did you hear about the Hozhoni Foundation?
If Other Website, College Job Board, Referral, or Other, please list:
