Employment Application : HASC Center

HASC Center Inc. is an equal opportunity employer. Applicants are considered without regard to race, creed, color, national origin, sex, age, disability, marital status, sexual orientation, veterans' status, citizenship status, or any other protected characteristic or status in all employment decisions, including but not limited to recruitment, hiring, compensation, training, promotion, transfers, termination, and all other terms and conditions of employment.

Please be aware that, if the position for which you are applying requires regular and substantial unsupervised or unrestricted physical contact with people being served by HASC Center, you will need to provide information, statements, and fingerprints according to the requirements of OMRDD regulations in order for a criminal background check to be conducted.

Personal Information

Have you ever applied for employment with HASC Center or any of its affiliates?

Yes No

Have you ever been employed by HASC Center or any of its affiliates before?

Yes No

First Name

Middle Name

Last Name

Present Mailing Address

City

State

Zip

Phone

Cell

Under 18

Yes No

How did you hear about this position?

Positions (s) Applied For

Salary Desired

Time Available

Full Time Part Time Other -

Hours

Date Available To Begin Work

Are you legally employable under U.S. Immigration Laws?

Yes No

Are you in the USA on a visa?

Yes No

A NYS driver's license is required for some positions. Do you possess a valid driver's license?

Yes No

Educational Information

Do you posses a high school degree or equivalency diploma?

Yes No

Computer Skills

Please list your familiarity with various software programs, operating systems and environments

Employment Experience

Are you presently employed?

Yes No

Name of Company

Start Date

End Date

Supervisor

Phone

Address

City

State

Salary

Position Held

Reason for Leaving

Responsibilities

Additional References

APPLICANT'S STATEMENT

I certify that the information contained in this application is true and correct to the best of my knowledge and understand that falsification or omission of information is grounds for refusal to hire or, if hired, immediate termination.
              
I further authorize the investigation of all information in this application for employment as may be necessary in arriving at an employment decision.

I further understand that if employed, I am employed at-will and that my employment can be terminated at my option or the option of the agency at any time and that no employee or representative of the agency, other than the Chief Executive Officer or Chief Operating Officer, has any authority to enter into any agreement or contract contrary to the above.

I also agree that I am required to conform to the policies, procedures, rules and regulations of the agency and that all offers of employment are conditioned on the satisfactory proof of my identity and legal authority to work in the United States.

Electronic Signature:

Check here for authorization