Hooley House Application for Employment

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general informationlocation(s) applied for:*BrooklynMentorMontroseWestlakePosition(s) applied for:*how did you find out about this job?*newspaperonlineemployeewalk inrelativeotherwhy are you seeking a new job at this time?*applicant informationname*Email*phone*address*if hired, do you have reliable means of transportation to get to work?*yes no if yes, please describe:*are you at least 18 years old?*yes no if you are under 18 years of age, can you provide a work permit?yes no are you legally eligible for employment in the u.s.?*yes no

(Proof of U.S. citizenship or immigration status is required if hired.)

have you been convicted of a crime?*yes no

(Massachusetts applicants should not include misdemeanor convictions; California applicants should not include marijuana-related convictions that occurred more than 2 years prior to the application date.)

If yes, state the nature of the offense and disposition of the case. Including dates and places.

(NOTE: The existence of a criminal record does not constitute an automatic bar to employment.)

are you a veteran?*yes no If yes, provide dates of servicelist any special skills or trainingemployment informationAre you seeking full time, part time or temporary employment?*What hours and shifts would you prefer to work?*List times you are not available to work.*willing to work overtime?*yes No Willing to Work Weekends?*yes No Willing to work Holidays?*yes No Are you currently employed?*yes No If hired, when would you be able to start?*Have you ever worked for this organization before?*yes No List any friends or relatives employed by this company:Have you ever been discharged or asked to resign from any position?*yes No If applicable, please refer to the attached job description for which you are applying. Are you able to perform all these tasks without reasonable accommodation?*yes No Please describe which tasks, if any, you will need accommodation to perform, and explain what type of accommodation you will need. If none, please enter "None."*EducationElementarySelect highest level achieved.*1 2 3 4 5 6 7 8 SecondarySelect highest level achieved.*9 10 11 12 GED Graduation yearIf in high school, are you enrolled in a recognized co-op program?yes No CollegeSelect highest level achieved.1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 YearsMore than 8 YearsDegree and MajorWork HistoryCurrent/Recent Employer*Employer 2For reference Purposes: Have you worked for any of these organizations or attended school under a different name?*yes No May we contact the employers listed above?*yes No If not, list the employers you do not wish us to contact and explain why.Authorizations and At-Will Employment Agreement

(please read carefully, then check the box below*)

I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification for my dismissal from employment if discovered at a later date. I agree to immediately notify this company if I should be convicted of a crime while my job application is pending or during my employment, if hired.

I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge.

I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company.

Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer.

I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations.

I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a post-job offer physical examination and my employment, in the event I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job-related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company-designated physician.

AT-WILL EMPLOYMENT AGREEMENT

I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create an employment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand that only the company’s President is authorized to change the employment-at-will status and such a change can only be done in writing.

I have read, understand and agree to the above*

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