*Position Desired      
*When Can You Start    
Salary Desired         
*Are You Currently Employed?                    NoYes
   If So, May We Contact Your Present Employer?  N/AYesNo
   Present Employer    
*Have You Ever Applied To HLTCC Before?         NoYes
   If Yes, When?       

Please check yes or no for each day and shift

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
AM	... Yes No	... Yes No	... Yes No	... Yes No	... Yes No	... Yes No	... Yes No
PM	... Yes No	... Yes No	... Yes No	... Yes No	... Yes No	... Yes No	... Yes No

Subjects of Special Study/Research Work or Special Training/Skills

U.S. Military Service NoneArmyArmy ReservesArmy National GuardNavyNavy ReservesAir ForceAir Forces ReserveAir National GuardMarine CorpsMarine Corps ReservesCoast GuardCoast Guard Reserves	Highest Rank Achieved N/AE-1E-2E-3E-4E-5E-6E-7E-8E-9E-9 SpecialW-1W-2W-3W-4W-5O-1O-2O-3O-4O-5O-6O-7O-8O-9O-10
U.S. Military Service NoneArmyArmy ReservesArmy National GuardNavyNavy ReservesAir ForceAir Forces ReserveAir National GuardMarine CorpsMarine Corps ReservesCoast GuardCoast Guard Reserves	Highest Rank Achieved N/AE-1E-2E-3E-4E-5E-6E-7E-8E-9E-9 SpecialW-1W-2W-3W-4W-5O-1O-2O-3O-4O-5O-6O-7O-8O-9O-10

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Employment History (list last four employers, starting with the last one first)

Date Employed

Name & Address of Employer

Salary

Position

Reason for Leaving

from to
from to
from to
from to

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References
Please list three persons not related to you, whom you have known at least one year.

Name

Address

Business

Years Known

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Resume
If you have a resume you would like to submit, then you may do so here. When you click the Resume Submit button, your e-mail program will open and you may send your resume as an attachment. Please submit it in Microsoft Word, Wordperfect or Adobe Acrobat format. You must still submit this form to complete the application process.

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Authorization
Please read before submitting your application online.

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize the investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

To agree to these terms, enter the last four numbers of your Social Security Number in the 'Digital Signature' area.
*Digital Signature                      

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Hattiesburg Lake Terrace Convention Center.
Copyright © 2005 [HLTCC],  All rights reserved.
Revised: April 11, 2008