Application for Employment
Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to complete the application and/or interview process should notify a representative of the Human Resources Department.
 
Position applied for: How did you hear about the position?
First Name Last Name
Address City
State Zip
Primary Telephone
(xxx-xxx-xxxx) 		Secondary Phone
E-mail Address  
Driver's license number if driving is an essential job function State
Have you ever been employed by HDA Merchandising before?
Are you legally eligible to work in this country?
Date available for work    
Type of employment desired
Have you been convicted of a crime in the last seven(7) years?
If yes, please explain:   
CONVICTION WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. EACH INSTANCE AND EXPLANATION WILL BE CONSIDERED IN RELATION TO THE POSITION FOR WHICH YOU ARE APPLYING.
How many years of merchandising experience do you have?
Do you have reliable transportation for multiple store daily visits?
Are you available to assist with resets or training of other merchandisers in your area?
Do you have consistent access to the following:
Computer
Printer
Internet Software Programs
Cell Phone
Do you have a high-speed internet connection, dial-up access, or neither?
For the purpose of this question, high-speed refers to connections that are always on (like broadband/DSL). Dial-up connections are only connected when needed (like NetZero, Juno, Earthlink dial-up, AOL dial-up).


Which days and how many hours are you available to work Monday – Saturday?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
This position requires that you lift up to 50 pounds and stay on your feet for up to 5 hours. Do you know of any reason that you could not perform these duties of the position with or without reasonable accommodation?
Employment History
Provide the following information for your past four (4) employers, assignments or volunteer activities, starting with the most recent
From To Employer Telephone
Job Title Address
Immediate Supervisor and Title City
Summarize the nature of work performed and job responsibilities State
Reason For Leaving Zip
Salary/Hourly Rate Start Per   
Salary/Hourly Rate End Per   
From To Employer Telephone
Job Title Address
Immediate Supervisor and Title City
Summarize the nature of work performed and job responsibilities State
Reason For Leaving Zip
Salary/Hourly Rate Start Per    
Salary/Hourly Rate End Per   
From To Employer Telephone
Job Title Address
Immediate Supervisor and Title City
Summarize the nature of work performed and job responsibilities State
Reason For Leaving Zip
Salary/Hourly Rate Start Per   
Salary/Hourly Rate End Per   
From To Employer Telephone
Job Title Address
Immediate Supervisor and Title City
Summarize the nature of work performed and job responsibilities State
Reason For Leaving Zip
Salary/Hourly Rate Start Per   
Salary/Hourly Rate End Per   
Skills and Qualifications
Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Educational Background
  Name and Location Years Completed Graduate? Degree? Course of study
High School
College
Other
Business References
Name Relationship Telephone Years known
I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer’s service, whenever it is discovered.

The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state, or federal law.

This application is current for 6 months. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and 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 representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.

I understand it is the company’s policy not to refuse to hire a qualified individual with a disability because of that person’s need for reasonable accommodation as required by the ADA.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization. Applicants are not obligated to disclose sealed or expunged records of conviction or arrest.

By submitting this application for employment to HDA Merchandising, I understand that investigative background inquiries are to be made on myself including consumer, criminal, driving and other reports. I also understand that HDA Merchandising will be requesting information from various federal, state, and other agencies which maintain public and non-public records concerning my past activities relating to my driving, credit, civil, education, and other experiences. I authorize, without reservation, any party or agency contacted by this employer to furnish the above mentioned information.
  - By checking this box, I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.