Ka Hale A Ke Ola | Homeless Resource Center Maui Employment Form

Employment Application

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Date
Date Format: MM slash DD slash YYYY
Renewed
Job / Position you are applying for:*
Personal Information
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Email
Enter Email Confirm Email
List any friends or relatives currently employed here:

Education
High School
Name of School*
Address*
Grade completed or degree*
College
Name of School
Address
No. of years attended
Grade completed or degree
Graduate
Name of School
Address
No. of years attended
Grade completed or degree
Medical Information
After an offer of employment is made, but before employment duties begin, applicants may be required to undergo a physical or medical examination (or drug test) at Company expense and by a Company-chosen physician, with the offer of employment conditioned on the result of such examination. Employees, at any time during the course of their employment, may be required to undergo a medical (or drug) examination at Company expense and by a Company-chosen physician. I authorize the physician conducting the examination and any laboratory testing any specimen obtained by the physician to disclose the results of the examination and the laboratory test to the Company.
Are you able to perform the essential functions of this job with or without reasonable accommodation?
Applicant's Initials
NOTE:
NOTE: It is the policy of this Company to hire only U. S. citizens and aliens who are authorized to work in this country. (As a condition of employment, you will be required to produce original document
Employment History
EMPLOYMENT RECORD: STARTING WITH present or MOST RECENT, list all previous employers. Include self-employment, military service, summer, and part-time jobs. Please attach additional sheets if necessary, following the same format.
1) Company Name*
Address*
Phone number*
Name of Supervisor*
Dates employed*
From To
State job titles and describe duties*
Reason for leaving*
2) Company Name*
Address*
Phone Number*
Name of Supervisor*
Dates employed*
From To
State job titles and describe duties*
Reason for leaving*
3) Company Name*
Address*
Phone number*
Name of Supervisor*
Dates employed*
From To
State job titles and describe duties*
Reason for leaving*
4) Company Name
Address
Phone number
Name of Supervisor
Dates employed
From To
State job titles and describe duties
Reason for leaving
References
Name
Phone
Occcupation
Address
Street Address City State ZIP Code
Name
Phone
Occupation
Address
Street Address City State ZIP Code
Attach Resume
By signing below, I certify that all statements made on this application are true and complete to the best of my knowledge. I understand that my application will not be considered if it is incomplete. Further, I understand that any misrepresentation or omission made herein, when discovered, will subject me to discharge. I authorize the Company to investigate my work history, education, character, reputation, and background as it deems necessary for purposes of considering my application for employment. In exchange for the Company’s consideration of my application for employment, I hereby release the Company and all providers of information (including, but not limited to, any of my former employers, educational institutions attended, and personal references) from all liability relating to or arising out of any inquiry by the Company regarding my work history, education, character, reputation, and background.

This application is not a contract of employment and cannot create a contract of employment for any specific period. I understand that if I am employed, my employment is “at will” and can be terminated at any time, either by myself or the Company, with or without cause or reason and with or without notice.
Terms*
- I have read and understand the terms of this application.
Signature
Phone
This field is for validation purposes and should be left unchanged.

Employment Application

Step 1 of 2

Personal Information

Education

High School

College

Graduate

Medical Information

NOTE:

Employment History

References

Attach Resume