HR Part Coordinator Form

HR Part Coordinator Form

Personal Information

Position Information

Position Applied For:    Department:

Location / Site:    Reporting Manager:

Are you available for overtime and weekend work when required? Yes No

Are you legally authorized to work in the country where this position is located? Yes No

Employment History (Most Recent First)

Employer 1

Employer 2

Education

Professional References (3)

Legal Disclosures and Authorizations

At-Will Employment: I understand that submission of this form and any offer of employment do not constitute a contract of employment for any specific duration. If hired, my employment will be at-will and may be terminated by me or the employer at any time, with or without cause and with or without notice, unless otherwise provided in a written agreement signed by an authorized representative of the employer.

Equal Employment Opportunity: The employer is an equal opportunity employer. Decisions regarding recruitment, hiring, promotion, compensation and other terms and conditions of employment are made without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable law.

Background Check Authorization: I authorize the employer or its agents to investigate my background, including criminal history, driving record, employment history, and education verification, as required for the position. I release the employer and those providing information from liability for furnishing and using such information.

Drug and Alcohol Testing: I acknowledge that pre-employment and/or post-accident drug and alcohol screening may be required as a condition of employment for safety-sensitive positions. I consent to such testing in accordance with company policy and acknowledge that refusal to submit to required testing may bar me from employment consideration or result in termination.

Criminal Conviction Disclosure: Have you ever been convicted of a felony or any offense related to dishonesty, theft, or workplace safety? Yes No If yes, explain:

Authorization to Contact Previous Employers: I authorize the employer to contact my previous employers and other references to obtain information regarding my work performance and qualifications. I understand that any false statement or omission of material fact may be grounds for refusal to hire or, if employed, termination.

Additional certifications or licenses relevant to the Part Coordinator role (e.g., forklift, inventory systems, hazardous materials) — list below:

Applicant Certification

I certify that all information provided in this form is true, complete, and correct to the best of my knowledge. I understand that materially false statements, omissions, or misrepresentations may result in denial of employment, discipline, or termination. I agree to notify the employer promptly of any changes to the information provided.

I understand and acknowledge that any offer of employment is conditioned upon satisfactory completion of reference checks, background checks, and any required drug testing. I hereby release all persons, companies, and institutions from any liability for providing such information.

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