Please enable JavaScript in your browser to complete this form. - Step 1 of 7Application for EmploymentAll applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, physical/mental disability, medical condition, military/veteran status, marital status, ethnicity, alienage or any other protected classification, in accordance with applicable federal, state, and local laws. Equal access to programs, services, and employment is available to all qualified persons. Position(s) Applied for *Date of Application *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name *FirstMiddleLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMain Phone Number *Secondary Phone NumberEmail *NextEmployment ExperiencePlease list the names of your present or previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references. Name of Employer *SupervisorMay we contact? *YesNoStreet AddressMain Phone Number *Begin Employment *End Employment *Begin PayEnd PayJob Titles and Duties *Reason for Leaving * Name of EmployerSupervisorMay we contact?YesNoStreet AddressMain Phone NumberBegin EmploymentEnd EmploymentBegin PayEnd PayJob Titles and DutiesReason for Leaving Name of EmployerSupervisorMay we contact?YesNoStreet AddressMain Phone NumberBegin EmploymentEnd EmploymentBegin PayEnd PayJob Titles and DutiesReason for Leaving Have you ever been involuntarily terminated or asked to resign from any job? *YesNoIf yes, please explain: Please explain any gaps in your employment history: Please list any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment:NextEducation Highest Level Completed: *High SchoolCollege / UniversityGraduate / Professional SchoolTrade SchoolOtherSchool Name: *Years Completed: *Diploma / Degree? *YesNoCourse of Study / Major:Specialized Training, Skills, or Extra-Curricular Activities: Highest Level Completed:High SchoolCollege / UniversityGraduate / Professional SchoolTrade SchoolOtherSchool Name:Years Completed:Diploma / Degree?YesNoCourse of Study / Major:Specialized Training, Skills, or Extra-Curricular Activities: Highest Level Completed:High SchoolCollege / UniversityGraduate / Professional SchoolTrade SchoolOtherSchool Name:Years Completed:Diploma / Degree?YesNoCourse of Study / Major:Specialized Training, Skills, or Extra-Curricular Activities:NextProfessional ReferencesPlease list three professional references of individuals who are not related to you. Name *FirstLastTitleEmail *Relationship *Phone Name *FirstLastTitleEmail *Relationship *Phone Name *FirstLastTitleEmail *Relationship *PhoneNextPersonal ReferencesPlease list three people who know you well. Name *FirstLastTitleEmail *Relationship *Phone NameFirstLastTitleEmailRelationshipPhone NameFirstLastTitleEmailRelationshipPhoneNextGeneral Information 1. Have you ever used another name? *YesNo2. Is any additional information relative to name changes, use of an assumed name, or nickname necessary to enable a check on your work and educational record? *YesNoa. If yes to either of the above, please explain:3. Have you ever worked for this company before? *YesNoa. If yes, please explain:4. Do you have friends and/or relatives working for this company? *YesNoa. If yes, please explain:5. On what date are you available to begin work? *6. Days available to work: *MondayTuesdayWednesdayThursdayFridaySaturdaySundayMonday Hours AvailableTuesday Hours AvailableWednesday Hours AvailableThursday Hours AvailableFriday Hours AvailableSaturday Hours AvailableSunday Hours Available7. Are you available to work? *Full-timePart-timeShift workTemporary8. Minimum salary desired:9. If hired, would you have a reliable means of transportation to and from work? *YesNo10. Can you travel if the position requires it? *YesNo11. Can you relocate if the position requires it? *YesNo12. Are you at least 18 years old? *YesNo13. If hired, can you present evidence of your identity and legal right to work in this country? *YesNo14. Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodation? *YesNoNote: We comply with the ADA and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.15. Have you ever been convicted of a felony? *YesNoa. If yes, additional information:NextApplicant Statement and Agreement Please read and check the box next to each paragraph below. If there is anything that you do not understand, please ask.I expressly authorize, without reservation, HIVELOCITY VENTURES CORPORATION (‘HIVELOCITY’), its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided be me in this application, resume or job interview(s). In addition, I hereby waive any and all rights and claims I may have regarding HIVELOCITY, its agents, employees or representatives for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.If hired, I understand and agree that my employment with HIVELOCITY is at-will, and that neither I, nor HIVELOCITY is required to continue the employment relationship for any specific term. I further understand that HIVELOCITY or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications. I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard. MY SIGNATURE BELOW ATTESTS TO THE FACT THAT I HAVE READ, UNDERSTAND, AND AGREE TO ALL OF THE ABOVE TERMS. Signature: *Clear SignaturePrint Name: *Date: *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920MessageSubmit
