Step 1 of 4 - Employment Application
Position Applying for:
FullTime or PartTime:
FullTime
PartTime
Are you interested in day shift or night shift?
Day Shift
Night Shift
Can you work 12 hour shifts?
Yes
No
General Information
Last Name:
First Name:
Middle Initial:
Street Address:
City:
Zip:
Years at Present Address:
Driver's License #:
Social Security Number:
Phone Number:
How did you learn about this position?
Email Address:
List all addresses lived at five years prior to this date:
Emergency Contact Information
Name:
Relationship
Phone #:
Personal Information
Are you under 18?
Yes
No
If under 18 years of age, can you submit a work permit?
Yes
No
Are you a Legal US Citizen?
Yes
No
If you are not a US citizen, do you have the legal right to remain permanently in the US?
Yes
No
Visa Number:
Do you have the legal right to work in the US?
Yes
No
Have you ever been convicted of, or pleaded guilty to a crime?
Yes
No
If YES, give the date, location, and crime:
Have you previously worked for this company?
Yes
No
List any friends or relatives currently working for or living at Hawthorn Glen:
Name:
Relationship:
Position:
Name:
Relationship:
Position:
Are you currently attending school?
Yes
No
If YES, where:
Course of study:
Do you plan on future education study?
Yes
No
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