APPLICATION FOR EMPLOYMENT

Hozhoni Foundation, Inc.

www.hozhoni.com — jobs@hozhoni.com

FLAGSTAFF
2133 N. Walgreen Street
Flagstaff, AZ 86004
Phone — 928.526.7944
Fax — 928.526.5909

PRESCOTT
195 Plaza Drive
Prescott, AZ 86303
Phone — 928.445.6996
Fax — 928.526.5909

Answer each question fully and accurately even if you submit a resume. No action can be taken on this application until you have answered all required questions, and you have signed your signature digitally.

Most form fields are required. An * (asterisk) indicates a required field. If you have no info for a required field, type None or NA.

At the bottom of the Application:

  • There is a field for additional info that you want us to know and consider.
  • You can upload a cover letter and resume if you want, but they are not required.
  • You can scroll up to any field to review or change an answer before submitting it.
  • Read the Affidavit, Consent and Release.
  • Click the Submit button to send your Application.
  • Sign your digital signature and print or save your Application as a PDF.

    * Indicates a required field

    Today's Date*

    Name*

    Home Address*

    City*

    State*

    Zip*

    Contact Phone*

    Email*

    Position Applying For*

    Date Available*

    Rate of Pay Desired*   $

    What shifts are you available to work*  Select all that apply.

    Are you 18 years of age or older*

    Are you legally eligible to work in the United States*
    Proof of eligibility will be required upon offer of employment.

    Have you ever been employed by Hozhoni before*
    If yes, list date(s) of employment and position(s) held below.

    Have you ever applied with Hozhoni before*
    If yes, tell us when below.

    List any relatives or people you know currently employed by, or receiving support from, Hozhoni*

    If hired, do you expect to be engaged in, or employed by, other companies outside of Hozhoni*

    If yes, please explain below.

    Have you ever been convicted of any crime*
    If yes, state the final disposition of the case, the date, and where it occurred below. A conviction will not be an absolute bar to employment.

    EDUCATIONAL INFORMATION

    Last high school name and location*

    High school last grade completed*  Select one.

    1. College, university, other school, location

    Dates attended
    From     To

    Total credit hours completed

    Type of degree earned   (if acquired)

    Curriculum

    Major

    Complete #2 and #3 below if you have more schools.

    2. College, university, other school name, location

    Dates attended
    From     To

    Total credit hours completed

    Type of degree earned (if acquired)  

    Curriculum

    Major

    3. College, university, other school name, location

    Dates attended
    From     To

    Total credit hours completed

    Type of degree earned (if acquired)  

    Curriculum

    Major

    List below any courses or workshops you have attended that relate to the job for which you are applying

    EMPLOYMENT HISTORY

    1. Present or Last Employer*

    Phone*

    Address*

    City*

    State*

    Zip*

    Dates Employed
    From*     To*

    Job Title*

    Pay*    $

    Supervisor's Name*

    Duties*

    Reason for Leaving*

    2. Employer

    Phone

    Address

    City

    State

    Zip

    Dates Employed
    From     To

    Job Title

    Pay    $

    Supervisor's Name

    Duties

    Reason for Leaving

    3. Employer

    Phone

    Address

    City

    State

    Zip

    Dates Employed
    From     To

    Job Title

    Pay    $

    Supervisor's Name

    Duties

    Reason for Leaving

    4. Employer

    Phone

    Address

    City

    State

    Zip

    Dates Employed
    From     To

    Job Title

    Pay    $

    Supervisor's Name

    Duties

    Reason for Leaving

    5. Employer

    Phone

    Address

    City

    State

    Zip

    Dates Employed
    From     To

    Job Title

    Pay    $

    Supervisor's Name

    Duties

    Reason for Leaving

    6. Employer

    Phone

    Address

    City

    State

    Zip

    Dates Employed
    From     To

    Job Title

    Pay    $

    Supervisor's Name

    Duties

    Reason for Leaving

    Have you ever been suspended, fired, or asked to resign*
    If yes, please explain below.

    If you are applying for a driving position, please complete the two questions below.

    Have you ever been convicted of, or pled guilty/no contest to, a driving offense as an adult, including DUI and reckless driving offenses (excluding minor traffic violations).
    If yes, please explain below.

    Have you had any accidents or received any moving violations during the past three years.
    If yes, explain each incident below in detail, giving dates, locations, and circumstances.

    REFERENCES

    1. Name*

    Title/Occupation*

    How do you know this reference*

    Phone*

    Years known*

    2. Name*

    Title/Occupation*

    How do you know this reference*

    Phone*

    Years known*

    3. Name*

    Title/Occupation*

    How do you know this reference*

    Phone*

    Years known*

    4. Name*

    Title/Occupation*

    How do you know this reference*

    Phone*

    Years known*

    5. Name*

    Title/Occupation*

    How do you know this reference*

    Phone*

    Years known*

    Use the area below for other information that you want us to know and consider.

    Upload your cover letter if you want. It is not required. Accepted files are pdf, doc, docx, txt. Maximum upload file size is 10MB.   

    Upload your resume if you want. It is not required. Accepted files are pdf, doc, docx, txt. Maximum upload file size is 10MB.   

    AFFIDAVIT, CONSENT, AND RELEASE.  Please read carefully.

    I certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that any falsifications, misrepresentations or omissions will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

    I understand that nothing in this application is intended to imply or create an employment relationship or contract for employment.

    I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by the Agency that such employment with the Agency is at will, for no specified duration, and may be terminated by either the Agency or me at any time, with or without cause or notice. I also understand that while personnel policies, programs, and procedures may of necessity change from time to time, such at-will status is not subject to change absent a written agreement signed by the Agency's CEO or a designated authorized representative. I understand that none of the documents, policies, procedures, actions, statements of the Agency or its representatives used during the employment process is deemed a contract of employment real or implied.

    I understand that if offered a position with the Agency, I may be required to submit to a pre- employment, post-offer medical examination, drug screening and background check as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.

    I hereby authorize the Agency and/or its assigns to investigate my personal history and to obtain from my previous employers any information they have concerning me.

    I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to the Agency and/or any of its representatives, agents or vendors and release all parties involved from any and all liability for any and all damage that may result from providing such information.

    This application for employment shall be considered active for a period of time not to exceed 30 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

    I HAVE READ, UNDERSTAND, AND BY MY INITIALS CONSENT TO THESE STATEMENTS.
    Your Initials*  

    This is the end of our Application for Employment.

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