MHRA Employee Application
Personal Information:
Full Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Date You Can Start
*
-
Month
-
Day
Year
Date
Hourly Wage Desired
Have You Worked Here Before?
Yes
No
Have You Applied Here Before?
Yes
No
Education:
Middle School (if not yet attended High School)
Name of High School Attended
High School
Name of High School Attended
Number of Years Attended
Number of Years Attended
College
Name of College/University Attended
Number of Years Attended
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Area of Study/Degree
Skills/Qualifications:
Skills
List any relevant skills
Qualifications
List any relevant certifications or qualifications
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Wage
Reason for Leaving?
Start Date
-
Month
-
Day
Year
Date
May We Contact?
Yes
No
Previous Employment:
Previous Employer
Name of Previous Employer
Position
Wage
Reason for Leaving?
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Previous Employer
Name of Previous Employer
Position
Wage
Reason for Leaving?
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
References:
Reference 1
Name of Reference
Relationship
Years Acquainted
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Reference 3
Name of Reference
Relationship
Years Acquainted
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Cover Letter & Resume (Optional):
Cover Letter
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of
Resume
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of
Date Completed
-
Month
-
Day
Year
Date
Submit
Should be Empty: