Employment Application

Position Applying For:

Department:

Part 1: Personal Information

I am 18 years or older

Yes

Last Name:

First Name:

Street Address:

City:

State:

Zip:

Home Telephone:

Work Telephone:

What is the best time and day to contact you?:

May we contact you via Email:

Yes

Email Address:

Employment Preference:

Part-Time

Full-Time

If part-time are there any times or dates you cannot or will not work?

Desired wage or salary:

Part 2: Professional Experience

Option 1: Paste Resume Here.

If you paste your resume in the space provided below Please proceed with the Part 3 of this Application.

Option 2: Enter Resume Information.

Education

Highest level of education:

Field of Study:

Work Experience.

List your last three positions held, starting with the most recent.

Employer #1

Present/Previous Employer:

City:

State:

Position:

Name of Supervisor?

Responsibilities:

Dates of Employment (Start)

Dates of Employment (End)

Reason for Leaving:

Salary:

Employer #2

Present/Previous Employer:

City:

State:

Position:

Name of Supervisor?

Responsibilities:

Dates of Employment (Start)

Dates of Employment (End)

Reason for Leaving:

Salary:

Employer #3

Present/Previous Employer:

City:

State:

Position:

Name of Supervisor?

Responsibilities:

Dates of Employment (Start)

Dates of Employment (End)

Reason for Leaving:

Salary:

List additional skills/training/education that qualify you for the position of interest:

Have you ever been employed by Hays Companies?

Yes

If yes, please provide the following information

Dates of Employment (Start)

Dates of Employment (End)

Location:

Position:

Part 3: Affirmative Action Information

Attention Applicants: Please review the following information.

AFFIRMATIVE ACTION INFORMATION

(Completion is voluntary)

We consider all applicants for positions without regard to race, color, religion, sex, national origin, citizenship, age,mental or physical disabilities, veteran/reserve/national guard or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.

In an effort to comply with requirements regarding government record keeping,reporting, and other legal obligations which may apply, we invite you to complete this applicant data survey. Providing this information is STRICTLY VOLUNTARY ,and will not be a part of your official application for employment. This will not be used for interview purposes, and failure to provide this information will not subject you to any adverse personnel decision or action. The information will be used and kept confidential in accordance with applicable laws and regulations.

Your cooperation is appreciated.

Today's Date (mm/dd/yyyy):

Position(s) applied For:

Applicant Information

Last Name:

First Name:

Street Address:

City:

State:

Zip:

Telephone No.:

Please check one of the following:

Male

Female

Please check one of the following Equal Employment Opportunity Identification Groups:

White (not of Hispanic Origin)

Black (not of Hispanic Origin)

Hispanic

American Indian/Alaskan Native

Asian/Pacific Islander

Please check disability status:

I am an individual with a disability --A person who (a) has a physical or mental impairment which substantially limits one or more major life activities; OR (b) has a record of such impairment; OR (c) is regarded as having such an impairment.

I am not disabled

Part 4: Resume

Use the following field to provide an electronic version of your resume.

Part 5: Signature

If you would like the opportunity to further explain your interest in opportunities available at Hays Companies please feel free to add your comments here:

By typing in your complete name and today's date, you are indicating that all of the information submitted by you is complete and true to your knowledge and that you have read and understand the information on this page.

I understand that if I am employed, false statements may result in my dismissal.

Name:

Today's Date (mm/dd/yyyy):

For security purposes, when submitting your information on-line, please type the letters displayed to the right into the text box provided below. All letters must be typed in uppercase.

Hays Companies is an Equal Opportunity Employer

Hays Companies' Career Opportunities

Employment Application

Education

Work Experience.

AFFIRMATIVE ACTION INFORMATION