Hillandale Family of Communities

Employment Application

Last Name:*

First Name:*

Middle Initial:*

Street:*

City:*

State:*

Zip:*

Phone:*

Fax:

Email Address:

Position(s) applying for:

Shift Desired:

Would you accept another shift?

How were you referred to Hillandale Communities?

Are you applying for :

Temporary work (ie. summer or holiday work)

Regular part-time work?

Regular full-time work?

If hired, on what date can you start working? * / /

Salary or hourly rate desired:

Are you available to work overtime?

Personal Information

Have you ever applied to/worked for Hillandale Communities before?

If yes, please explain (include dates):

Do you have any friends or relatives working for Hillandale Communities?

If yes, please state name and relationship:

Do you have any relatives residing at Hillandale Communities?

If yes, please state name and relationship:

If hired, do you have transportation to and from work?

Are you over the age of 18? (if under 18, hire is subject to verification of minimum legal age)

If hired, would you be able to present proof of your US citizenship or proof of your legal right to work in the United States?

Have you ever been convicted of a criminal offense (felony/misdemeanor)?

If yes, please describe the crime - state the nature of the crime(s), where and when conviction and disposition of the crime(s) :

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however be considered. Any arrest with or without conviction may delay the hiring process.)

Education, Training and Experience

High School:
Name:
City:
State:
Years Completed:
Diploma/Degree:

College/University:
Name:
City:
State:
Years Completed:
Diploma/Degree:

Vocational School:
Name:
City:
State:
Years Completed:
Diploma/Degree:

Military:
Name:
City:
State:
Years of Service:
Rank:
Branch:

List relevant certifications and licensure:

License/certification	Number	Expiration Date

Employment History
List most recent employment first, include gaps of employment and fill out completely.

Company

Position

Employment Dates: Start Date

End Date

Hourly Rate

Supervisor

Phone No.

Reason for Leaving:

May we contact this employer:

Company

Position

Employment Dates: Start Date

End Date

Hourly Rate

Supervisor

Phone No.

Reason for Leaving:

May we contact this employer:

Company

Position

Employment Dates: Start Date

End Date

Hourly Rate

Supervisor

Phone No.

Reason for Leaving:

May we contact this employer:

Company

Position

Employment Dates: Start Date

End Date

Hourly Rate

Supervisor

Phone No.

Reason for Leaving:

May we contact this employer:

An Equal Opportunity Employer
Hillandale Communities are an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accomodation in the application and/or interview process should notify a representative of the organization.

Applicant's Statement
I attest by clicking the submission button below that I have given to Hillandale Communities, true and complete information on this application. No requested information has been concealed. I authorize Hillandale Communities to contact references provided for employment reference checks. IF ANY INFORMATION I HAVE PROVIDED IS UNTRUE, OR IF I HAVE CONCEALED MATERIAL INFORMATION, I UNDERSTAND THAT THIS WILL CONSTITUTE CAUSE FOR THE DENIAL OF EMPLOYMENT OR IMMEDIATE DISMISSAL.

I agree that all questions asked and information released in good faith shall be privileged, and I expressly release Hillandale Communities, and any of their authorized representatives, from any and all liability arising from questions asked, information released or statements made.

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