Online Job Application

Please complete the application form below and click Send Application

* indicates required fields

To: HSA Protective Services- Human Resources

Contact Information

Agree to Acknowledgement and Consent *

Yes No
Read Acknowledgement and Consent
   
First Name * Middle Initial NMN = No Middle Name
Last Name *

Address 1 *

Address 2

City *

State *

 Zip Code *

e-mail Address
Home Phone *

Cell Phone

Page Number

Birth Date

(mm/dd/yyyy)

Position Information

Have you ever applied with HSA before? *

 Yes No
  If yes, Month & Year (mm/yyyy)
  What Position?

Do you own reliable transportation?

Yes No
  Make / Model

Position Desired

Pay Desired

Date Available

(mm/dd/yyyy)

Are you available for full-time work?

 Yes No

Are you available for part-time work?

 Yes No

Have you ever been convicted of a felony?

Yes No

Education
Do you have a valid California
Guard Card? *		 Yes No
School Location Course Study No. Years
completed		 Did you
graduate? 		Degree or
Diploma?
College Yes No

Business Trade or Technical

 Yes No
High School Yes No

Personal References (no relatives or previous employers)
Reference One
Name
Address
Phone Number
Reference Two
Name
Address
Phone Number
Reference Three
Name
Address
Phone Number

Previous Employment

(include the past 10 years, full-time and part-time, beginning with your present or most recent employer)

Employer One
(present- most recent)
Name
Address
Supervisor
Phone Number
State job title and describe Job duties
Employed From (mm/yy) To (mm/yy)
Hourly Rate Start Last
Reason For Leaving *
Employer Two
Name
Address
Supervisor
Phone Number
State job title and describe Job duties
Employed From (mm/yy) To (mm/yy)
Hourly Rate Start Last
Reason For Leaving
Employer Three
Name
Address
Supervisor
Phone Number
State job title and describe Job duties
Employed From (mm/yy) To (mm/yy)
Hourly Rate Start Last
Reason For Leaving

Military Experience

Did you serve in the U.S. Armed Forces?

 Yes No
  If yes, in what branch

Describe any training received relevant to the position for which you are applying.

How did you hear
about us?

 Search Engine (i.e. Google, Yahoo...)
Link From Another Web Site
Newspaper / TV / Ad
Craigslist
HSA Employee
HSA Client