Behavioral Health Services – A Business of Human Technologies Human Technologies Corporation Home

Employment Application

Thank you for your recent interest in career opportunities with Human Technologies. To continue the employment process, complete the form below:

We are proud to be an Equal Opportunity Employer. People with disabilities are encouraged to apply. Veterans are encouraged to apply.

Human Technologies is a Tobacco Free Company.

There are positions within Human Technologies subject to a background check. For details please speak with the Human Resources Department.

* indicates required field

*
*
Referral Source * Walk-in
Advertisement - Specify:
Employee - Specify:
Relative - Specify:
Government Agency (ie. ACCES-VR, OPWDD, etc) - Specify:
Private Employment Agency - Specify:
Other - Specify:

Resume Upload (optional)



Personal Information
 
*
*
*
*
*
*
*
am pm
* Yes No
Phone:
Time: am pm
If you are under 18, can you furnish a work permit?
  Yes No
Have you filed an application here before? *
  Yes No
Do you have family/friends who work for Human Technologies? *
  Yes, Name(s): No
Have you ever been employed here before? *
  Yes No
From: To:
Are you legally eligible for employment in the United States? *
  Yes No
Type of employment desired * Full-Time
Part-Time
Temporary
Seasonal
Work Tryout
Are you on layoff and subject to recall? *
  Yes No
Will you relocate if the job requires it? *
  Yes No
Will you travel if the job requires it? *
  Yes No
Are you able to meet the attendance requirements of the position? *
  Yes No
Will you work overtime if required? *
  Yes No
Have you ever been bonded? *
  Yes No
Have you EVER been convicted of a crime? *
(Such conviction may be relevant if job related, but does not bar you from employment. Include traffic violations, misdemeanors, felonies, etc.)
  Yes No

Number:
State:

Employment History
 
Most recent/current
Employer
Position
Address
Phone
Supervisor
Salary
Dates of Employment
Reason for Leaving
Job Duties
Employer
Position
Address
Phone
Supervisor
Salary
Dates of Employment
Reason for Leaving
Job Duties
Employer
Position
Address
Phone
Supervisor
Salary
Dates of Employment
Reason for Leaving
Job Duties

Education
 
  Name, City, State Degree / Diploma Type Date
High School
College
College
Graduate School
Business, Trade or Other

References - Give the names of professional references, not related to you, who may be contacted.
 
Name Address Phone Business Years Acquainted
May we request references from:
Your current employer? * Yes No
Your former employer(s)? * Yes No

Skills and Qualifications
 
Affirmative Action Plan Data
 
Applicants are treated during the hiring process without regard to: age, national origin, gender, religion, disability, sexual orientation, veteran status, marital status or any other legally protected status.
As a federal contractor, Human Technologies complies with all governmental regulations including Affirmative Action. Human Technologies collects data for recordkeeping, reporting and other legal requirements only.
Completing this form is OPTIONAL. If you choose to fill in the requested information, it will not be part of the hiring process. It will be maintained in a confidential file separate from your application and/or personnel file. Information provided or not provided will have no effect on the hiring decision.
  

Ethnic Origin: (choose ONE)

 
 
 
 
 
 

Veteran Status

 
 
 
 

 

Voluntary Self-Identification of Disability
 

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral Palsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular dystrophy
  • Bipolar disorder
  • Major depression
  • Multiple sclerosis (MS)
  • Missing limbs or partially missing limbs
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual disability (previously called mental retardation)

Please check one of the boxes below:




Your Name:
Today's Date:


Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.


i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Please check one of the boxes below:




Contact Information:
Your Name:
Today's Date:


It is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from Human Technologies service if I have been employed.

I give Human Technologies the right to investigate all references and to secure additional information about me, if job-related. I hereby release from liability Human Technologies and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

Human Technologies is an Equal Opportunity Employer. Human Technologies does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state or federal law.

This application is current for 1 year. At the conclusion of this time, if I have not heard from Human Technologies and still wish to be considered for employment, it will be necessary to fill out a new application.

I understand that just as I am free to resign at any time, Human Technologies reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of Human Technologies has the authority to make any assurances to the contrary.

I understand it is Human Technologies' policy to hire qualified individuals with disabilities and to recognize the need for reasonable accommodations that may be required by the ADA.

I further agree to hold harmless those employers, educational institutions and individuals releasing information to Human Technologies regarding my application for employment.

Human Technologies is a Tobacco Free Company.

There are positions within Human Technologies that are subject to a background check. For details please speak with the Human Resources Department.

I have applied for a position at the above indicated facility. I hereby authorize the release of any educational information and/or any information regarding my job performance to Human Technologies and its affiliates.

My name: *

I agree * I do not agree

HTC is proud to partner with…

AbilityOneACCSESNYSIDWorkability