Hogland Employment Application

Position(s) applied for

First and Last Name

Address

Telephone Number

Email Address

If you are under 18, and it is required, can you furnish a work permit? If you are under 18, and it is required, can you furnish a work permit? Yes No

If No, please explain

Have you ever been employed here before? Have you ever been employed here before? Yes No

If Yes, give dates and positions

Are you legally eligible for employment in this country? Are you legally eligible for employment in this country? Yes No

Date available for work

What is your desired salary range?

What is your Driver's License number? (A valid driver's license is required for this position.)

Have you ever pled "guilty" or "no contest" to, or been convicted of a crime? Have you ever pled "guilty" or "no contest" to, or been convicted of a crime? Yes No

If Yes, please provide date(s) and details

(EMPLOYMENT HISTORY) Employer 1 (Most Recent)

Employer 1 Dates employed (To and From)

Employer 1 Telephone Number

Employer 1 Immediate supervisor and title (for most recent position held)

Employer 1 starting/final job title

Employer 1 Summarize the type of work performed and job responsibilities.

Employer 1 What did you most like about your position?

Employer 1 What were the things you liked least about the position?

Employer 1 Why did you leave?

Employer 1 Compensation Starting

Employer 1 Compensation Ending

Employer 1 May we contact for reference? Employer 1 May we contact for reference? Yes No Later

(EMPLOYMENT HISTORY) Employer 2

Employer 2 Dates employed (To and From)

Employer 2 Telephone Number

Employer 2 Immediate supervisor and title (for most recent position held)

Employer 2 starting/final job title

Employer 2 Summarize the type of work performed and job responsibilities.

Employer 2 What did you most like about your position?

Employer 2 What were the things you liked least about the position?

Employer 2 Why did you leave?

Employer 2 Compensation Starting

Employer 2 Compensation Ending

Employer 2 May we contact for reference? Employer 2 May we contact for reference? Yes No Later

(EMPLOYMENT HISTORY) Employer 3

Employer 3 Dates employed (To and From)

Employer 3 Telephone Number

Employer 3 Immediate supervisor and title (for most recent position held)

Employer 3 starting/final job title

Employer 3 Summarize the type of work performed and job responsibilities.

Employer 3 What did you most like about your position?

Employer 3 What were the things you liked least about the position?

Employer 3 Why did you leave?

Employer 3 Compensation Starting

Employer 3 Compensation Ending

Employer 3 May we contact for reference? Employer 3 May we contact for reference? Yes No Later

What is the highest level of education you have attained? Include School Name, City and State)

Years Completed

Completed Completed Diploma GED Degree Certification Other

What is your degree?

What Certification(s)?

Other?

GPA/Class Rank

Major/Minor

Reference 1: List a business/work reference of a person not related to you. (Include: Name, Title, Relationship to You, Telephone#, and Number of Year(s) Known)

Reference 2: List a business/work reference of a person not related to you. (Include: Name, Title, Relationship to You, Telephone#, and Number of Year(s) Known)

Reference 3: List a business/work reference of a person not related to you. (Include: Name, Title, Relationship to You, Telephone#, and Number of Year(s) Known)

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize, without reservation, the employer, 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 by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, 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 understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. If l am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will be sufficient cause to (i) eliminate me from further consideration for employment or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered. Do you certify that you have read, fully understand, and accept all terms listed above? I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize, without reservation, the employer, 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 by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, 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 understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. If l am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will be sufficient cause to (i) eliminate me from further consideration for employment or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered. Do you certify that you have read, fully understand, and accept all terms listed above? Yes No