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Application for Employment

  1. Read this application carefully, there is a final portion that requires a preemptive step in order to complete this application. All links for downloads and uploads are within.

  2. (Initial)

  3. (Please upload below)

  4. (Must be active member)

  5. You may download separately with resume below.

  6. (Language, office equipment, machine operation, etc…)

  7. Please note this information will in no way disqualify you.

  8. If you meet the criteria for veteran preference points, please attach photocopy of DD214 or appropriate documents.

  9. (ie...DD214)

  10. List all jobs you have held in the last ten years. (Resumes may not be substituted) Include active military service, if any. PUT YOUR PRESENT OR MOST RECENT JOB FIRST. Provide all information relevant to the position for which you are applying. By being complete, you may improve your chances for employment. If you need more space, you may upload additional sheet(s) at the end of this section.

  11. Please provide immediate supervisor's name, title and phone number.

  12. Describe your duties and/or responsibilities as they relate to this position.

  13. Type in "Present" if present job

  14. Please provide immediate supervisor's name, title and phone number.

  15. Describe your duties and/or responsibilities as they relate to this position.

  16. Please provide immediate supervisor's name, title and phone number.

  17. Describe your duties and/or responsibilities as they relate to this position.

  18. Please provide immediate supervisor's name, title and phone number.

  19. Describe your duties and/or responsibilities as they relate to this position.

  20. After employment, you must submit proof of your legal right to work in the United States of America.

  21. I DECLARE UNDER PENALTY OF PERJURY THAT ALL THE ANSWERS AND STATEMENTS IN THIS APPLICATION ARE TRUE AND COMPLETED TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT UNTRUTHFULNESS OR MISLEADING ANSWERS ARE CAUSE FOR REJECTION OF THIS APPLICATION, REMOVAL FROM AN ELIGIBLE LIST OR DISMISSAL FROM HCFA EMPLOYMENT.

    I UNDERSTAND THAT A PHYSICAL EXAMINATION PRIOR TO EMPLOYMENT, AN ALCOHOL AND DRUG SCREEN, BACKGROUND INVESTIGATION, CREDIT CHECK, AND/OR D.M.V. CHECK MAY BE REQUIRED. I UNDERSTAND THAT THE RESULTS OF ANY OF THE FOREGOING MAY BE GROUNDS FOR DISQUALIFICATION.

  22. By inserting your full name, you hereby indicate that you have read and agree to the aforementioned affidavit.

  23. (Check all that apply)

  24. The information you provide in this section of this form will be detached from the application prior to the examination process.

  25. NOTE: If you have a disability which may require “Reasonable Accommodations” in the testing process, you need to obtain and complete a “Reasonable Accommodation Request Form” from Heartland Communications at the time of application.

  26. Heartland Communications Facility Authority requests that applicants voluntarily provide the following information. This information will not be included with your application, but will be available for research and evaluation purposes only. This information will have absolutely no effect on our selection process. Thank you for your cooperation.

    (check only one)

  27. By inserting your full name, you hereby indicate that you have read, acknowledged and completed the required portion of this section; And you have acknowledged, whether you completed or not, the voluntary information portion in this confidential section of this application.

  28. An additional document titled, "RELEASE AND WAIVER OF LIABILITY", is required as part of this application. Please download the page marked so, print and sign it then scan and upload it as part of this application.

  29. Leave This Blank:

  30. This field is not part of the form submission.