Application for Employment

	HN Research, LLC is an equal opportunity employer. Last Name: First Name: Middle Initial: Social Security Number: (Optional) (ex: 999-99-9999)   Street Address: City: State: Zip Code:   Home/Message Phone: ( ) Work Phone: ( ) Email Address:      What position are you applying for? Select From List Below Data Collection Supervisor Hospitality Positions In-Person Research Interviewer Research Interviewer Note: Please send cover letter and resume to Employment at HN Research (or via mail to13404 SW Chelsea Loop, Tigard, Oregon 97223, or by fax at 503-625-3438).   Date available for work?    Shift(s) Available:   Days    Evenings    Weekends Would you prefer to work:   Full time    Part time    Temporary   Will Visa or immigration status prevent lawful employment?   Yes    No   Proof of right to work in the U.S. will be required if hired.   Have you been convicted of a felony or released from prison within the past ten years for an offense which may reasonably relate to the job duties of the position for which you are applying? (A conviction may not necessarily disqualify you from employment.)    Yes    No   If yes, please indicate the date and nature of the offense:      What are your monthly starting salary expectations?   $ Have you ever previously applied to or been employed by this company?    Yes    No   If yes, when? How did you learn about this opening? Are you 16 years of age or older?    Yes    No If under 18, must have parent/school authorization before working.    EDUCATION GRADUATE   Name and Location of School Years Completed Yes No Degrees Received High School College Trade, Business, or Graduate School Were you known by any other name at any job or school listed on this application?      Yes    No If yes, what name? Indicate school or employer:     Typing WPM   Ten Key Touch   Sight PC's and software used Foreign Language Skills: Please supply us with a sample of your writing by telling us why you are seeking employment at HN Research:   EMPLOYMENT RECORD (INCOMPLETE APPLICATIONS CANNOT BE ACCEPTED) Please start with most recent employer, include military service. If currently employed, may we contact your employer?    Yes    No Employer: Type of business: Telephone: ( ) Address: City: State: Zip Code: Job Title: Supervisor: Telephone: ( ) Dates Employed:   From   To  Reason for leaving: Wage: Duties: Employer: Type of business: Telephone: ( ) Address: City: State: Zip Code: Job Title: Supervisor: Telephone: ( ) Dates Employed:   From   To  Reason for leaving: Wage: Duties: Employer: Type of business: Telephone: ( ) Address: City: State: Zip Code: Job Title: Supervisor: Telephone: ( ) Dates Employed:   From   To  Reason for leaving: Wage: Duties: REFERENCES (BUSINESS/PERSONAL) Name: Address: Telephone: ( )   Name: Address: Telephone: ( )   Name: Address: Telephone: ( )   APPLICANT'S STATEMENT By submitting this application, I certify that answers given herein are true and complete to the best of my knowledge. I authorize HN Research to investigate all statements contained in this application and to request information about me from previous employers and educational institutions. I expressly authorize my previous employers to provide information and opinions concerning my work and work habits. Further, I release all parties and persons connected with any requests for information from all claims, liabilities, and damages for whatever reason, arising out of furnishing any information that may be sought in arriving at an employment decision. Due to the enormous number of applications that HN Research receives, I understand HN Research cannot make any guarantees that my application will be considered for any or all open positions they may have, or that my application will be considered for any specific length of time. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in dismissal. I also understand that I am required to abide by all current and subsequently issued rules and regulations of the Company and that employment is for no definite period and may be terminated, at any time, with or without notice, by either party. Signed:    (Enter your full name in the box above before submitting application)