Please complete an online application!
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Please complete an online application!
All fields with an * are required.
1. Personal Information:
* First Name
:
* Last Name
:
* Present Address
:
* City
:
* State
:
* Zip Code
:
Email Address
:
* Home Phone Number
:
Cell Phone Number:
Are you 18 years of age or older?
yes
no
If you are not 18 years of age or older please enter your birthdate:
2. * Desired Employment -
Indicate by position or general interest area(s):
Do you want to work Full-time or Part-time?
full time
part time
If full-time position is not available, are you willing to work less than full-time?
Yes
No
* Specify days and hours you are available for employment
Have you worked for us before?
Yes
No
If yes, when?
If you have worked for HIT in the past, what name did you use if different than the name used above?
Do you have any relatives that currently work for HIT?
Yes
No
Comment:
A relative is defined to include spouses, parents, children, brothers, and sisters. The relationship shall also include those circumstances where two people reside together in a relationship characterized as a “significant other”.
If hired, on what date will you be available to start work?
What is the lowest entrance salary you will accept?
3. Military:
Have you ever been a member of the armed services or in a state militia?
Yes
No
If yes, did your military experience have any relationship to the position for which you have applied?
4. Education and/or Training:
Did you graduate from high school?
Yes
No
If not a high school graduate, do you have a GED equivalency certificate?
Yes
No
Formal education beyond high school (example: technical/vocational programs, colleges, universities):
First School
School Name:
Major Field:
Minor Field:
How long did you attend?
Type of Degree/Certificate Granted?
Second School
School Name
Major Field
Minor Field
How long did you attend?
Type of Degree/Certificate Granted?
Third School
School Name
Major Field
Minor Field
How long did you attend?
Type of Degree/Certificate Granted?
List job related workshops and seminars you have attended:
5. Licenses:
Please list professional license, certifications, registration or other forms of professional recognition which are job related:
Drivers License
License:
Date of Expiration:
Professional License
License:
Date of Expiration:
Other License
License:
Date of Expiration:
6. Volunteer Experience:
List job related volunteer and unpaid work experiences and indicate your responsibility, amount of time devoted to that activity each month, and dates during which work occurred:
7. Employment History:
Present or Most Recent Employer
* Employer
:
* Kind of Business:
* Street Address:
* City:
* State:
* Phone Number
:
* Your Title
:
* Name of Supervisor
:
* Your Duties
: (indicates size of business, specific job duties, related special assignments, supervisory responsibilities if any, etc.)
* Full-Time
:
* Part-Time
:
If part-time, number of hours per week
:
* Start Date
:
* End Date
:
* May we contact this employer?
* Reason for leaving
:
Starting wage
:
Ending wage
:
2nd Most Recent Employer
* Employer
:
* Kind of Business
:
* Street Address
:
* City
:
* State
:
* Phone Number
:
* Your Title
:
* Name of Supervisor
:
* Your Duties
: (indicates size of business, specific job duties, related special assignments, supervisory responsibilities if any, etc.)
* Full-Time
:
* Part-Time
:
If part-time, number of hours per week
:
* Start Date
:
* End Date
:
* May we contact this employer?
* Reason for Leaving
:
Starting wage
:
Ending wage
:
3rd Most Recent Employer
Employer:
Kind of Business:
Street Address:
City:
State:
Phone Number:
Your Title:
Name of Supervisor:
Your Duties: (indicates size of business, specific job duties, related special assignments, supervisory responsibilities if any, etc.)
Full-Time:
Part-Time:
If part-time, number of hours per week:
Start Date:
End Date:
May we contact this employer?
Reason for Leaving:
Starting wage
:
Ending wage
:
8. Personal References:
Do not include relatives or more than one member of a post secondary education and/or training program:
First Reference
* Name
:
* Phone Number
:
* Occupation
:
* Years Known
:
* Relationship
:
Second Reference
* Name
:
* Phone Number
:
* Occupation
:
* Years Known
:
* Relationship
:
Third Reference
* Name
:
* Phone Number
:
* Occupation
:
* Years Known
:
* Relationship
:
9. Background Information:
* Have you ever been convicted of a criminal activity (felony or misdemeanor)?
Yes
No
Indicating yes does not automatically disqualify you from employment.
Comments:
* Have you been convicted of or do you have a prior history of child or client abuse, neglect or mistreatment?
Yes
No
Comments:
Application Questionaire
* How do you feel you would be an asset to our company?
* Why would you like to work at HIT, Inc.?
* What do you think your strong points are as an individual?
How did you learn about the available jobs at HIT?
Please be specific as possible.
10. Certification
I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I understand that under Title VII of the Civil Rights Act of 1964, I cannot be discriminated against in employment, including consideration for promotion, for reasons of race, color, religion, national origin, sex, or on the basis of age, physical or cognitive impairment. I understand and agree that my relationship with HIT, Inc. would be voluntarily entered into and would be subject to termination by me or my employer at will, with or without cause, at any time either party would believe such action to be appropriate.
Release for Employment Application Information
I hereby authorize HIT, Inc. to process my application for employment by checking listed references and by verifying statements made on this “Application for Employment.” A photocopy of this release is as valid as the original for checking those references listed and for verifying statements made by checking with law enforcement agencies, the Drivers Licence Division and Child Neglect and Abuse Program of the Department of Human Services. I authorize investigation of all statements contained herein and I authorize all former employers and references listed in the application to give you any and all information concerning my previous employment and any pertinent information they may have, personal and otherwise. I also hereby release such individuals from whom HIT, Inc. may request information concerning me from all liability for any damage whatsoever incurred in furnishing information.
Drug/Alcohol Consent and Release (Pre-Employment)
I have been advised that if I become a finalist for the position applied for, a drug/alcohol screen is required as part of my pre-employment physical assessment, and that a drug/alcohol free finding is needed to qualify for employment with HIT, INC.
By marking this checkbox , I acknowledge this as my signature in the court of law
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