FHPL Employment Application Form

Personal Information:

Name(required)

Preferred Name

Email(required)

Phone Number(required)

Address(required)

Are you a US Citizen? (answer yes or no) (required)

Have You Ever Been Convicted of a Crime (Felony or Misdemeanor)? (answer yes or no) If Yes, please explain. (required)

If Selected for Employment Are You Willing to Submit to a Pre-Employment Drug Screening Test / Background Check? (answer yes or no)(required)

Position:

Position You Are Applying For(required)

Available Start Date:(required)

Desired Pay(required)

Type of Employment Desired:(required)

Full Time

Part Time

Availability : (check all that apply)(required)

Morning

Afternoon

Evening

Weekday

Saturday

Education:

School Name / Location / Years Attended / Degree Received / Major / Minor(required)

School Name / Location / Years Attended / Degree Received / Major / Minor

References – other than employers listed below or family members

Reference 1: Name / Company & Position / Relationship / Phone / Email(required)

Reference 2: Name / Company & Position / Relationship / Phone / Email(required)

Reference 3: Name / Company & Position / Relationship / Phone / Email

Employment History – please attach resume if possible

Employer 1: Job Title / Dates Employed / Starting Pay Rate / Ending Pay Rate / Address / City, State, Zip / Supervisor Name / Supervisor Email(required)

Employer 2: Job Title / Dates Employed / Starting Pay Rate / Ending Pay Rate / Address / City, State, Zip / Supervisor Name / Supervisor Email

Employer 3: Job Title / Dates Employed / Starting Pay Rate / Ending Pay Rate / Address / City, State, Zip / Supervisor Name / Supervisor Email

Employer 4: Job Title / Dates Employed / Starting Pay Rate / Ending Pay Rate / Address / City, State, Zip / Supervisor Name / Supervisor Email

Other:

Please give additional information or describe any skills, certifications, or experience that may be pertinent to this position

Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Name(required)

Date(required)