Beta Employment Application

Position Applying For?*

Resume Upload

Name*

FirstLast

Address*

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Home Phone*

Mobile Phone

Email*

Personal Information

Have you ever applied for a position with HRT (PENTRAN or TRT)?*

Yes
No

If yes, provide dates and position*

Have you ever been employed with HRT (PENTRAN or TRT)?*

Yes
No

If yes, provide dates and position held*

Do you have relatives employed with HRT?*

Yes
No

If yes, name of relative and position held*

Can you travel if a job requires it? *

Yes
No

Have you served in the U.S. Armed Forces? *

Yes
No

Branch*

Rank*

Date of Service (Started)*

Dates of Service (End)*

Have you ever been convicted of a misdemeanor or felony other than a minor traffic violation? (A conviction is not an automatic disqualification to employment. Each case is considered on a individual basis. Failure to disclose or falsify any information shall disqualify an applicant from employment and future employment considerations with HRT.)*

Yes
No

If yes, please give details*

If yes, does it relate to your ability to perform the job for which you are applying?*

Yes
No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*

Yes
No

Are you available to work:*

Full Time
Part Time
Temporary
Seasonal

If Part-time, what hours are you available?*

On what date would you be available to begin work?*

Is there anything that would prevent you from performing in a reasonable and safe manner the activities involved in the position for which you have applied?*

Yes
No

If yes, please give details*

Driving History

Do you have a valid driver’s license?*

Yes
No

State of Issue*

License Number*

Class

Endorsements

Restrictions

Expiration Date*

Have you ever had your Driver’s License revoked or suspended?*

Yes
No

If yes, when?*

Do you currently have a Commercial Drivers Permit or License, with the following Requirements? ( Class B or higher, P endorsement with air brakes ) *

Yes
No

Have you received any moving violations within the last five (5) years?*

Yes
No

If yes, please explain. *

What driving accidents have you had? (Please Expain)*

Education

Did you graduate or attend high school?*

Yes, graduated high school
No, obtained my GED

High School (Name and Location of School)*

High School (Number of Years Attended)*

High School (Degree Received)*

High School (Describe Course of Study)*

Did you attend Technical / Trade Schools?*

Yes
No

Name and Location of School *

Number of Years Attended *

Did you Graduate?*

Yes
No

Degree Received*

Technical / Trade School (Describe Course of Study)*

Did you attend Undergraduate College/ University *

Yes
No

Name and Location of School *

Number of Years Attended *

Did you Graduate?*

Yes
No

Degree Received*

Describe Course of Study*

Did you attend Graduate / Professional School?*

Yes
No

Name and Location of School *

Did you Graduate?*

Yes
No

Degree Received*

Describe Course of Study*

Describe any honors you have received

List professional, trade, business or civic activities and offices held. You may exclude memberships, which reveal sex, race, religion, national origin, age, ancestry and disability or other protected status.

Computer Software, Special Skills and Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.*

Licenses

If a license, certificate, or any other authorization to practice a trade or profession is required, complete the following section.

Type of License

License Number

Expiration Date

Granted By (Licensing Board)

Employment Record

Are you currently employed?*

Yes
No

May we contact your present employer for reference information?*

Yes
No

Are you currently on “Lay-Off” status and subject to recall?*

Yes
No

Have you ever been discharged or asked to resign from a position?*

Yes
No

If yes, please explain the circumstances*

Most Recent Jobs

Start with your most recent job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, sex, national origin, disability or other protected status. If you need additional space, please continue on separate sheet of paper.

1. Name of Employer*

From Date *

To Date

Address*

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Job Title*

Starting Salary*

Current/Last Salary*

Job Duties and Responsibilities*

Supervisor’s Name/Title*

Supervisor's Phone*

Reason for Leaving*

Check if additional employers are needed

additional employers needed

2. Name of Employer*

From Date *

To Date

Address*

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Job Title*

Starting Salary*

Current/Last Salary*

Job Duties and Responsibilities*

Supervisor’s Name/Title*

Phone*

Reason for Leaving*

Check if third employer is needed

third employer needed

3. Name of Employer

From Date

To Date

Address

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Job Title

Starting Salary

Current/Last Salary

Job Duties and Responsibilities

Supervisor’s Name/Title

Phone

Reason for Leaving

List any periods of unemployment and reason for unemployment*

APPLICATION STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that misrepresentation, falsification, or omission of information (given in my application or interviews) may result in discharge.

I authorize the HRT and its representative to investigate of all statements contained in this application for employment as may be necessary in arriving at an employment decision. As well as all other individuals whom HRT contacts, to provide the Agency any and all information concerning my previous employment and any other pertinent information that they may have. Further I release all parties and person from all liability for any damages that may result from furnishing such information to HRT as well as from the use or disclosure of such information by the Agency or any of its agents, employees, or representatives.

This application for employment shall be considered active for a period of time not to exceed one year. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby acknowledge that any employment relationships with this Company is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood this “at will” employment relationship may not be changed by any written document or by contract unless such change is specifically acknowledged in writing by an authorized executive of the Company.

I understand, also, that I am required to abide by all rules and regulations of the employer.

By checking yes you are agreeing with the APPLICATION STATEMENT above.*

Yes
No

Name*

FirstLast

Date*

Read instructions carefully before completing

Personal Information

Driving History

Education

Computer Software, Special Skills and Qualifications

Licenses

Employment Record

Most Recent Jobs

APPLICATION STATEMENT