HRAG Employment Application

WI - Employment Application
Use tab between fields to complete the Application, Motor Vehicle Record Release and 3 authorizations. Click SUBMIT, once completed to submit the form.

1. Contact Information *This question is required.

First Name *This question is required.

Last Name *This question is required.

Address (Street) *This question is required.

Address City *This question is required.

Address State *This question is required.

Address Zip Code *This question is required.

Best Contact Number *This question is required.

Email Address *This question is required. This question requires a valid email address.

2. Are you a smoker? *This question is required.

3. Are you 18 years of age or older? *This question is required.

4. Have you been convicted of a crime? *This question is required.

5. Why? *This question is required.

5. Position you are applying for *This question is required.

7. Date you are available for work *This question is required. This question requires a valid date format of MM/DD/YYYY.

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9. Education *This question is required. (Please include: (Name of institution, address, dates attended, major, degree), High School, Tech School, College, or Other)

10. Work Experience *This question is required. (Please include 3 Most recent companies: Company name, Address, start date/ end date, start pay/ end pay, reason for leaving, position and duties)

11. Supervisor

Name
Phone Number

12. May we contact your supervisor?

13. Please list any Awards, Training and Honors Received

14. Please Provide 3 References *This question is required. (Include name, relationship, number of years known and phone number)

15. Motor Vehicle Record Release & Authorization *This question is required.Check ALL the boxes below to signify that you understand and agree to the following:

To: Wisconsin Department of Transportation
I do hereby authorize the release and delivery of all motor vehicle driving records, including but not limited to personal information, to my prospective or present employer and its insurance agent.
This authorization shall continue in effect until revoked by me in a subsequent writing delivered to my prospective or present employer.
PLEASE NOTE: Due to Federal Privacy regulations the prospective or present employer is not able to provide you with a copy of any motor vehicle report or discuss its contents in any way.

Motor Vehicle Record
Use tab between fields and click SUBMIT to submit the form.

16. As listed on your driver's license

First Name *This question is required.

Last Name *This question is required.

Street Address *This question is required.

Address City *This question is required.

Address State *This question is required.

Address Zip Code *This question is required.

Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Gender *This question is required.

Male
Female

Driver's Licence Number *This question is required.

Driver's License Expiration Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

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17. Following 3 Authorization's Required *This question is required.Check ALL the boxes below to signify that you understand and agree to the following:

The following 3 authorizations consist of the Reference/Background Authorization, Drug Test Authorization and Certification of Truthfulness & Understanding of EMPLOYMENT-AT-WILL. Each one covers an important part of the job-related information, and of your future employment, if you are hired.
They are separate in order to emphasize each issue.
You are urged to carefully read each before signing.
If you have any questions, please ask a recruitment manager or office manager for help.

18. Reference / Background Authorization *This question is required.Check ALL the boxes below to signify that you understand and agree to the following:

I understand that references will be contacted, and that appropriate work-related references are not limited to those listed in my application.
I authorize my prospective employer to contact and secure information about my educational background, work experience, credit rating, and to secure records of licensing, administrative, regulatory or any other governmental agency, and to contact any other information source relevant to employability.
I hereby release my prospective employer, its subsidiaries, officers and agents from liability for seeking such information, and all other persons, schools, corporations or organizations for furnishing such information.
In processing this employment application, we may request that an investigative consumer report be prepared, which may include information as to your employment, finances, and general reputation.
You have the right to request that we completely and accurately disclose to you the nature and scope of the investigation requested. Such a request must be made in writing to this prospective employer within a reasonable time after you complete this application. A separate information and authorization document will be provided if a consumer report is to be done.

19. Drug Test Authorization *This question is required.Check ALL the boxes below to signify that you understand and agree to the following:

I understand and AGREE that a Drug Screening Test is a condition of application for employment, and will be done prior to employment.
I understand that positive testing results may be grounds for refusal to hire.
I also understand and AGREE that the company reserves the right to require me to submit to a drug or alcohol screening test at any time after employment, and may also require me to submit to work-related medical examinations during the course of my employment.

20. Certification of Truthfulness & Understanding of EMPLOYMENT-AT-WILL *This question is required.Check ALL the boxes below to signify that you understand and agree to the following:

I certify that the facts contained in this application are true and I understand that any false or misleading statements, or omissions in this application may result in rejection of this application or, if hired, in discharge.
I understand that the prospective employer is an EMPLOYER-AT-WILL, which means that if I am hired, my employment is for no definite period, and may be terminated at the will of myself or my employer, at any time, without notice, for any reason, or for no reason.
No employee of the company is authorized to promise me anything contrary to what is stated in this application, and I may not rely on any such representations.
I also understand that all rules manuals, employee handbooks, or personnel policies are descriptive only. They do not form any sort of contract between myself and the employer, and they may be unilaterally changed, or not applied, as the prospective employer believes to be in the best interest of the company at the time.

21. Electronic Signature of AGREEMENT & APPLICATION *This question is required. Electronically signing gives Consent to gather information regarding candidates Motor Vehicle Record, Reference/Background Authorization, Drug Test Authorization and Certificate of Truthfulness & Understanding of Employment-At-Will.

HRAG Employment Application - WI