EMPLOYMENT APPLICATION
Fields marked with (R) are required.

NAME: (R)
STREET: (R)
CITY: (R)
STATE: (R)     ZIP CODE: (R)
TELEPHONE NUMBER: (R)
EMAIL: (R)

EMPLOYMENT DESIRED
DEPARTMENT:
POSITION APPLYING FOR: (R)

HAVE YOU EVER WORKED FOR HGC? Yes    No
HAVE ANY RELATIVES WORKED FOR HGC? Yes    No
IF YES, WHAT IS HIS/HER NAME?

MILITARY SERVICE
HAVE YOU EVER SERVED IN THE U.S. ARMED SERVICES? Yes    No
BRANCH OF SERVICE:
INITIAL RANK:
FINAL RANK:
SPECIAL TRAINING:

HEALTH RECORD
DO YOU HAVE ANY PHYSICAL OR MENTAL DISABILITIES WHICH PREVENT YOU FROM PERFORMING CERTAIN KINDS OF WORK? Yes    No

IF YES, DESCRIBE DISABILITY AND SPECIFIC WORK LIMITATIONS:


HAVE YOU EVER RECEIVED WORKER'S COMPENSATION FOR AN INDUSTRIAL ILLNESS/INJURY? Yes    No

IF YES, WHAT TYPE OF INJURY?

EDUCATION:
HIGH SCHOOL NAME: (R)
ATTENDED: year(s), From (R)    To (R)
DID YOU GRADUATE? Yes    No (R)

COLLEGE NAME:
ATTENDED: year(s), From    To
COURSE OF STUDY:
DID YOU GRADUATE? Yes    No
LIST DIPLOMA OR DEGREE:

EMPLOYMENT:
ARE YOU CURRENTLY EMPLOYED: Yes    No (R)
CURRENT EMPLOYER:
STREET:
CITY:
STATE:     ZIP CODE:
TELEPHONE NUMBER:
HOW LONG? Year(s)    Month(s)
FROM:     TO:

PREVIOUS EMPLOYER:
STREET:
CITY:
STATE:     ZIP CODE:
TELEPHONE NUMBER:
HOW LONG? Year(s)    Month(s)
FROM:     TO:

PREVIOUS EMPLOYER:
STREET:
CITY:
STATE:     ZIP CODE:
TELEPHONE NUMBER:
HOW LONG? Year(s)    Month(s)
FROM:     TO: