HIRING HALL APPLICATION

Please print All questions must be answered An Equal Opportunity Employer

CONTACT INFORMATION
Name:

Address:
(Street)

(City) (State) (Zip)

Home / Cell Phone(s): Do you have any legal restrictions working around children? Yes No

Date of Birth: __________________ Are you an Erie County Resident? Yes No

E-Mail Address: __________________ Do you have a Valid NYS Driver License? Yes No
AREA / TRADE OF INTEREST
Future Trade / Career : List any Trade(s) Experience:
Yes
Are you interested in Training / Certification: Yes No Do you have a Rsum: (Attach) No
TRAINING INTEREST (Please Skip if not interested)
1. Do you have reliable transportation? Yes No

2. Are you aware you may be required to pass a drug test? Yes No

3. If required have you registered with selective services? Yes No (To check visit: https://www.ss.gov/Home/Verification)

4. Do you have any outstanding student loans? Yes No

5. Have you ever received funding for jobs training? Yes No If yes, please list Organization / Date _____________________

6. Are you available for Morning & Evening Training Hours? Yes No If No, please list availability _____________________
EDUCATION
Please check the last year of formal education completed:
9 10 11 12 13 14 15 16 17 18 18+

If you did not complete high school, do you have a high school equivalency diploma (GED)? Yes No

Did you
Name and Location of Type of Degree or graduate?
Institution Diploma Major course of study
Yes No
High School
College or Yes No
Technical School
Yes No
Graduate School

Other Training or Skills (Machines operated, special courses, computers, typing, special licenses, permit or certificates)

Applicant Name (Please print.) ________________________________________________________________________

Applicant Signature:______________________________________________________ Date:______________________

Parent / Guardian Name (Please print.) (Required if under 18) ____________________________________________

Parent / Guardian Signature:_______________________________________________ Date:______________________

350642593 Revision 2/7/17