Have you previously applied for a position with Helac Corporation?
Yes      No
If yes, approximate date of application

Have you ever been employed by Helac Corporation?
Yes      No     
From: To:

If less than 18 years of age, state your date of birth

Have you been convicted of a felony within the last 7 years?
(Please note that a felony conviction may not necessarily disqualify you from employment.)
Yes      No
 

If yes, please explain:

What position are you applying for?

Type of Employment Preferred - Please check all applicable boxes:

Were you known by any other name at any job or school listed on this application?
  Yes   No
If yes, what name(s)? 
Please indicate each school and/or employer:

Name of current or last employer:

Type of business:

Street address


City

State

Postal code

Phone

Position/Title

Dates of employment
From:      To:

Starting Salary

Ending Salary

Immediate Supervisor

May we contact for reference?
 Yes  No

Primary Responsibilities, Duties, and Skills Demonstrated:

Reason(s) for leaving:

Name of next employer:

Type of business:

Street address


City

State

Postal code

Phone

Position/Title

Dates of employment
From:      To:

Starting Salary

Ending Salary

Immediate Supervisor

May we contact for reference?
 Yes  No

Primary Responsibilities, Duties, and Skills Demonstrated:

Reason(s) for leaving:

Name of next employer:

Type of business:

Street address


City

State

Postal code

Phone

Position/Title

Dates of employment
From:      To:

Starting Salary

Ending Salary

Immediate Supervisor

May we contact for reference?
 Yes  No

Primary Responsibilities, Duties, and Skills Demonstrated:

Reason(s) for leaving:

Please explain any gaps in your employment history listed above:

 

PRE-EMPLOYMENT DRUG SCREENING

Helac Corporation believes in a drug-free workplace. The manufacture, dispersion, possession, use, or distribution of an illegal drug, non-prescribed drug, or alcohol is prohibited during the entire work shift, on company property or in company vehicles. Violation will result in disciplinary action up to and including termination. In order to maintain a drug-free environment. Helac, as part of it's drug policy, uses drug screening test to ensure that conditional employees are not currently engaged in the use of illegal drugs, as allowed by state law.

Before you may commence employment, you must sign an agreement to submit a urine sample for testing and pass a drug screening process. Testing will take place at a company selected clinic at the company's expense. If you fail to sign the pre-employment drug screening consent, or test positive on the drug screening test, you will be denied employment. Any attempt to adulterate or interfere with the substance abuse testing process will result in a withdrawl of the employment offer.

You will not be permitted to commence employment until you have passed the drug screening test. However, passing the drug screening test does not guarantee continued employment.

If, for any reason, you do not wish to comply with these policies, please discontinue the application process.

CERTIFICATION

I certify that the information in this application is complete and correct to the best of my knowledge. I understand that falsification, omissions, or misleading information of any kind may be grounds for termination of my employment, should I be selected for a position. I expressly authorize the references listed on this application to provide Helac with any and all information concerning my previous employment and education. I release all parties from any and all claims and/or liability for damages that may result from furnishing this information to Helac.

I understand and agree that during the course of my employment, Helac reserves the right to request its employees to submit to drug and/or alcohol screening for current use of illegal drugs and/or on duty impairment by alcohol. I understand and agree that my personal property I bring on the company premises (including the parking lot) may be searched for illegal drugs or alcohol, for reasonable cause. I understand and agree that if I accept employment with the company, the forementioned will be terms and conditions of my employment.

I understand that all company rules and regulations will be subject to applicable federal, state, and municipal law.

In consideration for my employment, I agree to abide by the present and future rules and regulations of Helac, and I understand that my employment and compensation can be terminated with or without cause and with or without notice at any time at the option of either Helac or myself. I understand that no employee or representative of Helac, other than the President, has the authority to enter into any agreement for employment for any specified period of time, to make any agreement that is contrary to the foregoing, to make any promises of specific treatment in specific situations, or to make any contractual agreement with me.

Applications are kept active for 90 days. If, after 90 days, you are still interested in a position with Helac, submit a new application for employment.

When I SUBMIT this application I certify that I have read and understand the above statements.