HumanKind Employment Services Application

HumanKind Employment Support
I would like help with the following(check all that apply)

Applying for unemployment or resolving an issue related to unemploymentCreating or editing my resumeEducation or trainingSearching for a jobCompleting a job applicationPreparing for an interviewFinding community resourcesOther

Contact Information
Name*

PrefixFirst NameMiddle NameLast NameSuffix
E-mail
Phone
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Authorization To Release and Exchange Confidential Information
I authorize Presbyterian Homes & Family Services, Inc. DBA HumanKind to:

Exchange (share and receive) information with:

Potential and previous employers, other HumanKind program staff, community partners, other area workforce providers as well as county and state funded agencies.

The following information pertaining to myself:

Employment history and income; credit history; child care; school status; and other such documents that are related and/or required in order to provide services.

For the purpose of:

Performing due diligence, as well as the necessary transactions in order to manage your account. We restrict access to this information to only those persons who need to know it in order provide you with products or services and for reporting to funding sources.

I understand that the information may be shared through the following methods:

Verbal phone conversation, electronic mail (email), facsimile. This consent will automatically expire 2 years after service has ended.
Signature*

Clear
Date*

MonthDayYear
Date
Privacy Policy
It is the policy of HumanKind to protect the confidential information of its customers in the context of sound business relationships. The following is our policy on the collection, use and disclosure of the information we receive from consumers and customers.

We collect: (a) Information and supporting documentations, such as names, addresses, employment history and income; (b) the information we receive from an individual’s experiences with us, and with other service providers.

We have developed and we maintain strict physical, electronic and procedural safeguards that comply with federal regulations to protect all of this personal information. We restrict access to this information to only those persons who need to know it in order to provide a person with products or services. We share information regarding our customers, former customers and third parties only in accordance with these strict standards and confidentiality policies, and, only as may be necessary to assist a program participant.
Signature*

Clear
Date*

MonthDayYear
Date
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HumanKind Employment Support

Contact Information

Demographic Information

Employment Information

Authorization To Release and Exchange Confidential Information

Privacy Policy