AID352 | HMG JB Forms

Personal Information
Are you at least 18 years of age and do you have the legal right to work in the United States?*
- Yes
- No
Are you willing to to take a drug test?*
- Yes
- No
First Name*
Middle Name

(As it appears on your Social Security Card)
Last Name*
Nickname/Preferred Name
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Mobile Phone
Email Address*
Cover Letter
(Optional)
How will you submit your resume?*
- Upload
- Paste
If you do not have a resume, select Paste and type “NA” in the Text Resume field.
Upload Resume*
Accepted file types: doc, docx, txt, Max. file size: 50 MB.
Word document or Rich text
Text Resume*
If you do not have a resume, type “NA” in the Text Resume field.

Education
Enter most recent - Do not enter start and end date if the most recent is high school.

If you do not recall your exact start and end dates, please provide your best estimate.
Type of school
Name of School
Start Date
Month
Day
Year
End Date
Month
Day
Year
Street Address
City
State
Zip Code
Degree Earned
Major Study Area
Other Studies

Employment History
Please list most recent experience first.

If you do not recall your exact dates of employment, please leave DD field as is, and enter the month and year only.
If you did not attach your resume to this application, you must fill out this section completely.
Start Date
Month
Day
Year
End Date
Month
Day
Year
Company Name
City
State
Supervisor Name
Job Title
Job Duties
May we contact this employer for a reference check?
- Yes
- No
Previous Position
If you do not recall your exact dates of employment, please leave DD field as is, and enter the month and year only.
Start Date
Month
Day
Year
End Date
Month
Day
Year
Company Name
City
State
Supervisor Name
Job Title
Job Duties
May we contact this employer for a reference check?
- Yes
- No
Previous Position
If you do not recall your exact start and end dates, please provide your best estimate.
Start Date
Month
Day
Year
End Date
Month
Day
Year
Company Name
City
State
Supervisor Name
Job Title
Job Duties
May we contact this employer for a reference check?
- Yes
- No

PLEASE READ THIS CERTIFICATION AND AGREEMENT CAREFULLY BEFORE SIGNING

By my signature on this Employment Application, I certify that all information furnished by me and in any resume I have supplied, is true, complete and correct. I agree that any false statement made by me, or my failure to answer completely any applicable questions may result in release from, or refusal of, employment. I authorize my former employers and any other persons or organization to provide any accurate information they have regarding my background, and I release all concerned from any liability in connection therewith, and I promise I will not bring any legal claims or actions against my current or former employers or any other person due to their responses to any job reference request.

If hired, as an employee of the Company, I will follow the rules, regulations and policies of the Company, which will govern the terms and conditions of my employment. If I am hired, I understand the employment relationship will be at-will, meaning I am not guaranteed employment for any definite period, and my employment relationship may be terminated at any time, without cause or notice, for any or no reason, by either the Company or myself. I understand any agreement to the contrary must be in writing and signed by an authorized representative of the Company. I certify that no employee or representative of the Company has made any oral or written representation to me or entered into any agreement with me that is contrary to this Certification and Agreement. I further understand and agree that, except for employment-at-will status, if hired my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by the Company.

I understand that the Company may share the information contained in this Employment Application with other Company employees for employment and administrative purposes and hereby consent to such transfer.

I understand that if I am offered employment, such offer will be contingent upon passing a Company-approved background check and drug screen (unless prohibited by state law), and that I will be required to supply proof of authorization to work in the U.S. I also understand that I will be required to authorize the drug testing firm to provide the results of the required drug test to the Company. I also understand and agree that by signing and submitting this Employment Application, I am waiving my right to have a jury trial to resolve any lawsuit I may ever bring against the Company, and that any lawsuit that I may bring against the Company will be tried to a judge without a jury. I also understand and agree that I am waiving my right to participate as a member in a class action lawsuit and/or act as a representative of a class of similarly situated individuals in any lawsuit against the Company. I understand that unless I waive these rights, the Company will not further consider my application for employment.

By signing and submitting this Employment Application, I certify I am genuinely interested in working for the Company in the position which I am applying and am submitting this Employment Application for no other purpose. I understand that I am applying for temporary or contract assignments. I acknowledge that I have read this Employment Application carefully and understand its content.

MASSACHUSETTS APPLICANTS: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liabilities.

MONTANA APPLICANTS: The employment relationship is governed by the Wrongful Discharge from Employment Act. Mont. Code 39-2-901.

Please take a moment to review your application. Indicate that you have read the above statement by entering your initials in the box below. To complete this application, click on the Submit button.
Initials*
This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.
Phone
This field is for validation purposes and should be left unchanged.

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Personal Information

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