Job Center

To apply for a position in our callcenter or warehouse, please fill out this questionnaire.
First NameMiddle Name
Last Name
Email Address
Phone #Best Time To Call
Are you 18 or older?yes no
Street Address
CityStateZip
Have you been known by another name?yes noIf yes, what?
Your interest in Heartland America
 Call Center Warehouse Data Entry Other:
 Full Time (36 hours or more per week)
 Part Time (29 hours per week or less)
 Part Time Plus (30-35 hours per week)
 Seasonal
Range of hours you're available to work:
Days you're available to work:
Have you applied at Heartland America before?yes noIf yes, when?
Have you worked at Heartland America before?yes noIf yes, why did you leave?
How did you hear about us?Please select one
Heartland America Website
Newspaper:
Online:
Heartland America Employee:
Other:
Employment History
Please give an accurate, full time and part time employment record. Start with your present or most recent employer.

1
EmployerTelephone
Address
Supervisor's Name and Title
Employed    from To
Describe the Work you did
Hourly Rate    Begin End
May we contact this employer?yes  no
Explain your reasons for leaving

2
EmployerTelephone
Address
Supervisor's Name and Title
Employed    from To
Describe the Work you did
Hourly Rate    Begin End
May we contact this employer?yes  no
Explain your reasons for leaving

3
EmployerTelephone
Address
Supervisor's Name and Title
Employed    from To
Describe the Work you did
Hourly Rate    Begin End
May we contact this employer?yes  no
Explain your reasons for leaving

Education
List the highest level of education achieved
Name and Address of School
Years Completed1  2  3  4Did you graduate?yes  no
Course of StudyDegree Earned

Have you completed any other courses or training programs that would impact your work at Heartland America?

Do you have experience in any of the following areas? Check all that apply.
SalesTelemarketing - Inbound or Outbound
RetailUpselling products or services
None of the Above

Do you have customer service or related experience?yes no
Are you familiar with a keyboard, and do you have basic computer skills?yes no
References
1  
2  
3  
If offered a position, when would you be able to start?
ImmediatelyWithin 2 weeksWithin one monthMore than one month