Applicants are considered for positions without regard to race, color, religion, sex, national origin, age, non-performance related disability or any other legally protected status. In the event you are contracted for an interview, please request in advance any disability-related accommodations required for the interview.

    Position of Interest (required)

    Application Date (required)

    Name (required)

    Email Address (required)

    SSN# (required)

    Address (required)

    Telephone (required)

    Date Available(required)

    Are you known to schools/reference by another name? (required)
    yesno

    If yes, by what name(s)?

    Have you ever been employed here before? (required)
    yesno

    If yes, in what capacity?

    Are you available to work: (required)
    Full-timePart-timeweekends

    Are you able to perform the essential functions of the position for which you are applying? (required)
    yesno

    Do you have a valid driver’s license? (required)
    yesno

    If yes, for what state?

    Can you travel if the job requires it? (required)
    yesno

    Are you under the age of 18? (required)
    yesno

    Have you ever been convicted of a criminal offense? (required)
    yesno

    If yes, please describe the nature of the offense and the date and jurisdiction where the conviction occurred.

    (Note: A criminal offense is NOT an automatic disqualification for all jobs, but may affect your suitability for some positions.)

    Are you prevented from lawfully becoming employed in the United States because of immigration status?
    (required)
    yesno

    (Proof of citizenship or immigration status will be required upon employment)


    Employment Experience

    Start with your present or last job. Include military service assignments and volunteer activities.

    You may exclude organization names which indicate race, color religion, sex or National origin.

    __________________________________________________________________________________________

    Employer (required)

    Dates Employed (required)

    Address (required)

    Job Title (required)

    Hourly Rate/Salary (please include starting and final rate) (required)

    Work Performed (required)

    Supervisor (required)

    Telephone (required)

    Reason for leaving: (required)

    Job Title (required)

    May we contact
    (required)
    yesno

    __________________________________________________________________________________________

    Employer (required)

    Dates Employed (required)

    Address (required)

    Job Title (required)

    Hourly Rate/Salary (please include starting and final rate) (required)

    Work Performed (required)

    Supervisor (required)

    Telephone (required)

    Reason for leaving: (required)

    Job Title (required)

    May we contact
    (required)
    yesno

    __________________________________________________________________________________________

    Employer (required)

    Dates Employed (required)

    Address (required)

    Job Title (required)

    Hourly Rate/Salary (please include starting and final rate) (required)

    Work Performed (required)

    Supervisor (required)

    Telephone (required)

    Reason for leaving: (required)

    Job Title (required)

    May we contact
    (required)
    yesno

    __________________________________________________________________________________________

    Employer (required)

    Dates Employed (required)

    Address (required)

    Job Title (required)

    Hourly Rate/Salary (please include starting and final rate) (required)

    Work Performed (required)

    Supervisor (required)

    Telephone (required)

    Reason for leaving: (required)

    Job Title (required)

    May we contact
    (required)
    yesno

    __________________________________________________________________________________________

    Education

    High School

    Year Graduated

    College/University

    Years Attended

    Describe course of study, extracurricular activities and other pertinent information:

    Summarize special skills and qualifications acquired from employment or other experiences:

    List professional, trade, business, or civic activities and offices held. (You may exclude those which indicate race, color, religion, sex, national origin, or age):

    List special licenses or certifications:

    Is there any other information about you that should we know to evaluate your candidacy for the position for which you are applying? Please describe fully:

    References

    Name

    Relationship

    Company/Address

    Telephone

    __________________________________________________________________________________________

    Name

    Relationship

    Company/Address

    Telephone

    __________________________________________________________________________________________

    Name

    Relationship

    Company/Address

    Telephone

    __________________________________________________________________________________________

    Name

    Relationship

    Company/Address

    Telephone

    __________________________________________________________________________________________

    I certify that the information provided is correct and that no information has been withheld that might adversely affect my chances for employment. I understand that a false statement (s) of the omission of a fact may result in the rejection of the application-or discharge of employment.

    I authorize Focus HR, Inc. to investigate my references, prior employers and all statements related to my suitability for employment contained in this application. I authorize all prior employers and educational institutions to release all records related to my application for employment. I release and hold harmless Focus HR, Inc. and anyone providing information from all claims or liabilities arising out of the information provided.

    I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.

    I understand that this application will be considered only for the specific open position(s) in which I have indicated an interest. If I accept an offer of employment made by an authorized representative of Focus HR Inc., I understand that I am required to abide by all policies and regulations.

    By Checking this box I verify that I understand and agree with all the provisions listed above.