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000-000-0000
1234 Your Street
Apt., Unit, Number, etc.
youremail@url.com
Are you currently employed?

Have you ever been employed by Handmaker?

Provide dates of employement
Are you at least 18 years of age? (If under 18, hire is subject to verifications of minimum legal age)

Were you referred to Handmaker by one of our employees?

How often would you like to work?


Which shifts are you able to work?


Are you legally eligible for employment in the United States?

If hired, can you provide proof of U.S. Citizenship, or proof of your right to live and work in the U.S.?

Do you have a reliable means of transportation to and from work?

Are you able to perform the essential functions of the job for which you are applying?


Note: HJSA complies with the ADA and considers reasonable accommodation measures that may be necessary for applicants/employees to perform essential job functions.
Please note: All certificates must be provided at time of hire. Please list by TYPE/LICENSE NUMBER/EXPIRATION DATE
Has your professional license ever been suspended or revoked?


High School/GED

Please provide name of school, location, and years completed.
Did you graduate?

Technical or Nursing School

Please provide name of school, location, and years completed.
Did you graduate?

College or University

Please provide name of school, location, and years completed.
Did you graduate?

Graduate School

Please provide name of school, location, and years completed.
Did you graduate?

References

Name/Occupation/Phone Number
Name/Occupation/Phone Number
Name/Occupation/Phone Number

Current Employer

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Résumé Upload

Upload your résumé
Accepted file types: .doc, .docx, .pdf, .txt

Please read the information provided below.

HJSA is an equal opportunity provider and employer, and selects individuals best matched for the job based upon job-related qualifications regardless of race, religion, color, creed, sexual orientation, national origin, age, disability, or any other status or characteristic protected by law.

I certify that all statements contained in this application (including attachments, if any) are true to the best of my knowledge. If HJSA, during it’s investigation, or later if I am employed, discovers that statements have been omitted or are false or misleading, I understand that I may receive no further consideration for employment and that this may be grounds for dismissal. My electronic signature above authorizes all current and prior employers, educational institutions and branches of the United States Armed Services, whether listed above or not, to furnish HJSA with complete information concerning my employment, academic transcripts, and service records. The information requested may include inquiries regarding my work habits, other related activities, abilities, character, and the cause of my separation.

I hereby authorize HJSA to investigate my personal history and to obtain from my previous employers or personal references any information they have concerning me. I am hereby informed that as part of the employment procedure, an investigative consumer report may be made whereby information is obtained through mail, telephone and personal interviews with previous employers, personal references, friends and/or others with whom I am acquainted or have been employed. This inquiry, if made, may include information as to my character, general reputation, personal characteristics and work habits. I understand that HJSA may be requesting information concerning my motor vehicle operation history and criminal history from various states, private and insurance sources along with other public records available. Further, I understand I have the right to make a written request within reasonable time to receive additional detailed information about the nature and scope of any investigation that is made. I am fully aware and understand that my employment may be subject to meeting HJSA standards with respect to an employment screening and/or an employment substance abuse test. If employed, I understand that such employment is at will, and as such is for no specific duration and may be terminated at any time with or without cause.

I release each of the above references and HJSA and authorized representatives from any liability for damages, which might result from the furnishing of or the use of any of this information. I understand that completion of this application does not indicate that there are any positions open and does not obligate this company to hire me or offer me a job.

In consideration of my employment, I agree to conform to the rules and regulations of HJSA.

Handmaker Jewish Services for the Aging is an equal opportunity provider and employer. No discrimination is made against any individual in any phase of employment in accordance with local, state and federal laws.

Your typed name serves as your signature and states you have carefully read and acknowledge the statement above.

Type your full name.