H&H Specialties — Employment Application

Personal Information

Please complete all required fields marked with an asterisk (*).

Contact Information

Last Name *

First Name *

Middle Name

Street Address *

City *

State *

Zip Code *

Home Phone

Cell Phone *

Email Address *

Position Details

Earliest Available Start Date *

Pay Rate / Salary Desired

Position(s) Applying For * (Select all that apply)

Hours Desired

Full Time

Part Time

Employment Status

Regular

Temporary

Shifts Available (Select all that apply)

Days

Evenings

Weekends

Eligibility

Are you authorized to work in the United States on an unrestricted basis? *

Yes

No

Can you perform the essential functions of this position with or without reasonable accommodation? *

Yes

No

Education & Qualifications

List any education or training related to the position you're applying for.

Highest Level of Education Completed

Schools / Training Programs

School / Program 1

School Name

Degree / Certificate

City / State

School / Program 2

School Name

Degree / Certificate

City / State

Other Training / Certifications

School / Program Name

Degree / Certificate

City / State

Special Skills

Describe any special skills, certifications, or experience relevant to this position

Work History

Start with your most recent position and work backwards. Include paid and unpaid positions.

Most Recent Position

Job Title

Start Date

End Date

Company Name

Supervisor

Phone

City

State

Duties / Responsibilities

Reason for Leaving

May We Contact This Employer?

Yes

No

N/A

Previous Position #2

Job Title

Start Date

End Date

Company Name

Supervisor

Phone

City

State

Duties / Responsibilities

Reason for Leaving

Previous Position #3

Job Title

Start Date

End Date

Company Name

Supervisor

Phone

City

State

Duties / Responsibilities

Reason for Leaving

Previous Position #4

Job Title

Start Date

End Date

Company Name

Supervisor

Phone

City

State

Duties / Responsibilities

Reason for Leaving

Professional References

Please list three professional references not related to you. If you do not have three professional references, personal references are acceptable.

Reference 1

Full Name *

Phone Number *

Relationship

Address / City / State

Reference 2

Full Name

Phone Number

Relationship

Address / City / State

Reference 3

Full Name

Phone Number

Relationship

Address / City / State

Additional Information

Background Disclosure

A conviction does not automatically disqualify you from employment — each situation is reviewed individually based on the nature of the offense, the time elapsed, and the position applied for.

Have you ever been convicted of a felony? *

Yes

No

If yes, please explain (nature of offense, date, and disposition)

Résumé (Optional)

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Upload your résumé (PDF, Word, or TXT — optional)

Choose File

Applicant Certification

I certify that the facts set forth in this application are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions, or misrepresentations may result in my dismissal. I authorize Hearth & Home Specialties to make an investigation of any of the facts set forth in this application and release the employer from any liability in doing so.

I acknowledge and understand that Hearth & Home Specialties is an "at-will" employer. Therefore, any employee may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice.

Applicant Signature (type your full legal name) *

Electronic Signature

Date *

H&H

Specialties

Motor Vehicle Report (MVR) Authorization

Please read the notice below carefully before signing.

The Fair Credit Reporting Act (FCRA) provides individuals with certain rights regarding consumer reports and places certain obligations on employers using consumer reports for employment-related purposes. Consistent with the FCRA's requirements, this notice is provided to inform you that Hearth & Home Specialties may, for employment-related purposes (including evaluating you for initial employment, eligibility as an insurable driver, promotions, transfers, assigned duties, and retention as an employee), obtain from a consumer reporting agency one or more consumer reports containing financial information, criminal record information, driving record information, and/or other relevant information about you.

The information contained in this report may be shared with the company's insurance agent and/or insurance carrier to determine whether an employee is or is not insurable per general carrier guidelines. Hearth & Home Specialties or their insurance agency will not obtain a consumer report without your signature below authorizing us to obtain one or more consumer reports.

I hereby acknowledge that I have read and understand the contents of the above notice and specifically authorize Hearth & Home Specialties or their insurance agency and/or insurance carrier to obtain and/or share one or more consumer reports on me for employment-related purposes as indicated above.

Authorization to Obtain Consumer Reports

Full Name *

Date of Birth *

Driver's License Number *

Driver's License State *

Applicant Signature *

Sign here with your finger or mouse

Electronic Signature — Legally binding digital authorization

Date *

Tape Measure Reading Test

Field positions require the ability to accurately read a tape measure.

Instructions: Each ruler below shows a measurement. The blue shaded area represents the tape measure blade pulled out to a certain point. Read the measurement at the right edge of the blue shading and enter your answer in the box provided.

Format examples: 5 3/4 · 12 1/16 · 9 1/2 · 7 (whole inches only)

Apply for Employment

Contact Information

Position Details

Eligibility

Schools / Training Programs

Special Skills

Background Disclosure

Résumé (Optional)

Authorization to Obtain Consumer Reports