Form Hrd 278 PDF Details

Finding the right path to a fulfilling career within the University of Hawai'i system means navigating through various administrative procedures, one of which includes the completion of the HRD 278 form. This document, critical for anyone aiming to secure a non-civil service appointment, serves as the primary application vehicle. Applicants are urged to fill it out with the utmost attention to detail, ensuring that all information—from personal data to employment history—is accurately represented in blue or black ink. The form not only gathers essential qualifications and experiences pertinent to the job in question but also seeks to understand the applicant's legal eligibility for employment. It meticulously covers various aspects, including past dismissals from employment, criminal records related to controlled substances, and any history of convictions that may affect one's ability to serve responsibly. Additionally, the form requests information on any licensure that may be relevant to the position applied for, driving home the importance of transparency in one’s application. As an equal opportunity employer, the State of Hawai'i's commitment to fair hiring practices is evident in the comprehensive nature of the HRD 278 form, ensuring candidates from all walks of life are considered on a fair and equal basis.

QuestionAnswer
Form NameForm Hrd 278
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesE-MAIL, hrd 278 fillable dlnr, Dismissals, legibly

Form Preview Example

STATE OF HAWAI‘I APPLICATION FOR NON-CIVIL SERVICE APPOINTMENT

UNIVERSITY OF HAWAI'I

OFFICE OF HUMAN RESOURCES

2440 Campus Road

Administrative Services Building #2

Honolulu, Hawaii 96822-2246

FOR OFFICIALUSE ONLY

DEPARTMENTALPERSONNELSTAFF

TOSELECTCATEGORY.

Exempt

 

TAOL

89 Day

 

 

___________

RECEIVED DATE/TIME STAMP

GENERALINSTRUCTIONSTOAPPLICANT: Please type orprint legibly in blue orblack ink.

The information you provide will be used to determine whether you qualify for the job(s), for which you are applying.

Your entire application and attachments (if any) must be received only at the Personnel Office above.

This application form is to be used for non-civil service appointments.

Before applying, read the position requirements described in theAnnouncement carefully to determine if you qualify for the position.

AnyadditionalrequiredformsdescribedintheAnnouncementcanbeobtainedfromthisoffice.

Answer the questions completely and accurately. Your application may be rejected if it is incomplete or you may be disqualified or dismissed from employment if you provide false information.

Youmustnotifythisofficeinwritingofanychangestoyourname,addresses,telephonenumbersoravailabilityinformation.

We will not be responsible for any mail or correspondence which does not reach you.

Your application and supporting documents are confidential and become our property. Please keep copies for your own record.

The information you submit on this form may be verified.

The information on pages 1 and 2 will not be released to persons involved in the appointment process.

TheStateofHawai‘iisanequalopportunityemployerandcomplieswithapplicablestateandfederallawsrelatingtoemploymentpractices.

1.

POSITION TITLE APPLYING FOR

2.

RECRUITMENT NUMBER or POSITION NUMBER

3.NAME:

Last

First

Middle

OTHERNAMES

USEDORFORMER

4.LASTNAME:

MAILING

5.ADDRESS:

P.O. Box

or

Number and Street

 

 

 

City

State

Zip Code

E-MAIL

6.ADDRESS:

PHONE

7.NUMBER:

Home Other

8.CITIZENSHIPSTATUS.

The State of Hawai‘i requires that all persons seeking employment with the government of the State shall be citizens, nationals, or permanent resident aliens of the UnitedStates,oreligibleunderfederallawforunrestricted employment in the United States.

I acknowledge I have read and understood the above information.

9.NOTICEOF“ATWILL”EMPLOYMENT

Thejobyouareapplyingforistemporaryinnature. Therefore, ifappointedtotheposition,youremploymentwillbeconsidered to be “AtWill,” which means that you may be discharged from your employment at the prerogative of the department head or designee at any time.

CERTIFICATE OFAPPLICANT

I have been informed and understand that this application is for considerationofajobthatistemporaryinduration,haslimitedor no benefits, and employment, if offered, is only on an “At Will” basis. I hereby certify that all statements in this application are true and correct to the best of my knowledge, and I agree and understand that any misstatements of material facts herein may cause forfeiture of all rights to any employment in the service of theStateofHawai‘i. Ihavereadthetermsorconditionsstatedon this application and understand that there may be additional employment-related tests as required.

Date

Original Signature ofApplicant

StateofHawai‘iDepartmentofHumanResourcesDevelopment

Page 1

FormHRD278(Rev.10/2013)

STATE OF HAWAI‘I APPLICATION FOR NON-CIVIL SERVICE APPOINTMENT

The information on pages 1 and 2 will not be released to persons involved in the appointment process.

Informationrequestedinitems10through19isneededtomakedeterminationsonyoursuitabilityforemployment.Dismissals fromemploymentordishonorableseparationsfrommilitaryservicedonotautomaticallydisqualifyyoufromemployment. The circumstances of each individual case will be evaluated against the requirements of the position for which you have applied, to determine suitability for employment.

10. DISMISSALSFROMEMPLOYMENTAND/ORDISHONORABLESEPARATIONSFROMMILITARYSERVICE

Withinthepastfiveyears,wereyou:

 

 

A)Fired,terminatedforcause,dismissed,dischargedoraskedtoresignfromemployment?

YES

NO

B)Separatedfrommilitaryserviceunderconditionsotherthanhonorable?

YES

NO

(If you answer “Yes” to question 10Aor 10B, please explain in detail in item #11 below, the dates and reasons for your dismissal from employment or separation from military service. For dismissals from employment, provide also the name and address of the employer.)

11.____________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

12.WITHINTHEPASTTHREE(3)YEARS,HAVEYOUBEENCONVICTEDOFANY

OFFENSE RELATEDTO CONTROLLED SUBSTANCES?

YES

NO

(If you answer “Yes” to the above question, pleaseexplainindetailinitem#13below,the dates, nature and circumstances of the conviction; the sentence imposed and its current status; and any other relevant information you wish to provide.)

13.____________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

14.HAVEYOU EVER BEEN CONVICTED OFANYACT,ATTEMPTOR CONSPIRACYTO

OVERTHROWTHE STATE OR FEDERALGOVERNMENTBYFORCE ORVIOLENCE?

YES

NO

(If you answer “Yes” to the above question, pleaseexplainindetailinitem#15below,the dates, nature and circumstances of the conviction; the sentence imposed and its current status; and any other relevant information you wish to provide.)

15.____________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

16.SUSPENSIONORREVOCATIONOFLICENSE

Wasyourlicenseorcertificationtopracticeinaregulatedprofession(forexample,

physician,engineer,nurse,plumber,etc.)eversuspendedorrevoked?

YES

NO

(Ifyouanswer“Yes,”pleaseexplainindetailinitem#17below,thetypeoflicense;thedate;thestate;thespecific board or organization that suspended or revoked your license; the circumstances of the suspension or revocation; and any other relevant information you wish to provide.)

17.____________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

18.SETTLEMENTSORAGREEMENTS

Haveyouacceptedasettlement,acashbuyoutsuchasthroughtheState’sSeparationIncentiveProgram

orareyousubjecttoanyrestrictionlimitingorprecludingyoufromseekingorsecuringemployment

 

 

withtheStateofHawai‘i?

YES

NO

(Ifyouanswer“Yes,”toquestion18,pleaseexplainindetailinitem#19below,thereasonanddateofyoursettlement

 

orrestrictionfromapplyingwiththeStateofHawai‘i.)

 

 

19._____________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

StateofHawai‘iDepartmentofHumanResourcesDevelopment

Page 2

FormHRD278(Rev.10/2013)

STATE OF HAWAI‘I UNIVERSITY OF HAWAI'I – OFFICE OF HUMAN RESOURCES

 

FOR OFFICIAL USE ONLY

 

 

 

 

EDUCATION AND EMPLOYMENT HISTORY

 

 

 

 

DEPARTMENTAL PERSONNEL

STATE OF HAWAI‘I APPLICATION FOR NON-CIVIL SERVICE APPOINTMENT

 

 

STAFF TO SELECT CATEGORY

 

 

 

 

1. POSITION TITLEAPPLYING FOR:

 

 

Exempt

TAOL

 

 

 

2. RECRUITMENT NUMBER or POSITION NUMBER:

 

 

89 Day

_________

Asrequiredbyfederaland/orstatelaws,wedonotdiscriminate on the basis of age, sex (including gender identity or expression), religion, race, color, ancestry, national origin, disability, marital status, veteran’s status, sexual orientation, arrestandcourtrecord,citizenship,geneticinformationorany otherprotectedcharacteristic.TheStateofHawai‘iisanequal opportunityemployerandcomplieswithapplicablestateand federal laws relating to employment practices.

3.

NAME:

 

 

 

 

 

 

 

 

 

 

Last

 

First

Middle

 

4.

OTHER NAMES

 

 

 

 

 

USED OR FORMER

 

 

 

 

 

 

 

LAST NAME:

 

 

 

 

 

 

5.

E-MAIL

 

 

 

 

 

 

 

ADDRESS:

 

 

 

 

 

 

6.

MAILING

 

 

 

 

 

 

 

ADDRESS:

 

 

 

 

 

 

 

 

 

 

P.O. Box

or

Number and Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

State

Zip Code

 

7.PHONENO.:

 

 

 

 

Home

Other

 

8.EDUCATIONHISTORY:Whenverificationisrequired,thedocumentationmustbesubmittedatthetimeoftheapplication.Ifnot,youmaynotreceivecredit

DO NOT

forthetrainingand/oryourapplicationmaybeconsideredincompleteandrejected.Theinformationyouprovideinthissectionwillbeusedstrictlyintheevaluationof

WRITE

your qualifications for

the

position(s) for which you are applying. The information you submit on

this form may be verified.

IN THIS

 

 

 

 

 

 

SPACE

A.NAMEAND LOCATION (city and state) of last grade school attended: (elementary, intermediate or high school)

 

 

(School name/type)

 

 

(City/State/Country)

 

 

 

 

 

 

 

 

 

Did you graduate?

Yes

No If no, what grade level did you complete? _____

 

 

 

Did you receive a GED?

Yes

No

 

 

 

 

 

 

B.TRAINING:In-servicetraining,business,trade,armedforces,collegeoruniversity,graduateofprofessionalschools.

 

 

NAME & ADDRESS

CourseorMajor

NumberofCredits

KindofDegree,

FieldofStudy

orHoursCompleted

DiplomaorCertificate

 

Semester

Quarter

Received

 

 

 

 

9.LICENSES,CERTIFICATES,OTHERQUALIFICATIONS

A.DRIVER’SLICENSE:

Yes, I have a valid driver’s license or I am able to obtain a valid driver’s license by the time of appointment.

No, I do not have a driver’s license and/or I am not interested in being considered for positions which require a driver’s license.

B. OTHER LICENSES OR CERTIFICATES: Please indicate the kind, registration number, and the State or other licensing authority. If proof of evidenceisrequired,pleasesubmitaphotocopyorpresentforverification.

C. KNOWLEDGE OF LANGUAGE OTHER THAN ENGLISH: List the languageandchecktheappropriateblock(s).Somepositionsrequiretheability tospeak,read,and/orwriteinalanguageotherthanEnglish.

D. SPECIAL QUALIFICATIONS: Include membership in professional or scientific societies, honors, awards, fellowships, publications (list but donotsubmitunlessrequested),etc.

LANGUAGE

SPEAK READ

WRITE

StateofHawai‘iDepartmentofHumanResourcesDevelopment

Page 3

FormHRD278(Rev.10/2013)

EDUCATION AND EMPLOYMENT HISTORY

STATE OF HAWAI‘I APPLICATION FOR NON-CIVIL SERVICE APPOINTMENT

10.EXPERIENCE: Please type or print legibly in ink. Begin with your present or last employment/training and work backwards. Describe all employment/training,includingmilitaryserviceandvolunteerwork. Useseparateblocksifyourdutiesandresponsibilitieschangedwhileworkingfor the same employer. To receive full credit for your experience, describe in detail the tasks you were assigned. If you supervised others, explain your dutiesasasupervisorandindicatethenumberandjobdutiesofemployeesyousupervised.Ifmorespaceisneededprovidetheinformationonablank sheettitled“Experience”andattachittothisform.Informationyousubmitonthisformmaybeverified.

Donotsubmitaresumeinplaceofcompletingthispage.

 

POSITION

 

Employer_________________________________________________

From:_________________________________

 

 

 

 

 

 

Address__________________________________________________

Month

Year

 

 

 

 

To:____________________________________

 

 

 

______________________________________________________________

Month

Year

 

 

LAST

 

Supervisor’sNameandTitle ____________________________________

FullTime

PartTime

Volunteer

 

 

CompanyPhoneNumber _____________________________________

Averagehoursworkedperweek

____________

 

 

CompanyURLInternetAddress_________________________________

 

 

 

 

 

OR

 

YourPositionTitleandDuties___________________________________

Starting Salary

$___________ Per ______

 

 

 

 

 

 

 

 

 

 

PRESENT

 

_______________________________________________________________

Ending Salary

$___________ Per ______

 

 

________________________________________________________________

Reason(s)forleaving_____________________

 

 

_______________________________________________________________

________________________________________________

 

 

_______________________________________________________________

________________________________________________

 

YOUR

 

________________________________________________________________

Maywecontactthisemployer?

Yes

No

 

 

Doyousupervise?

Yes

No Ifyes,howmanyemployees?_____

 

 

 

 

 

 

 

 

Employer____________________________________________________

From:_________________________________

 

Address_____________________________________________________

Month

Year

 

 

To:____________________________________

 

 

_______________________________________________________________

 

 

 

 

 

 

 

Month

Year

 

 

Supervisor’sNameandTitle ______________________________________

FullTime

PartTime

Volunteer

 

CompanyPhoneNumber _________________________________________

Averagehoursworkedperweek

____________

 

CompanyURLInternetAddress____________________________________

 

 

 

 

 

YourPositionTitleandDuties______________________________________

Starting Salary

$___________ Per ______

 

_______________________________________________________________________

Ending Salary

$___________ Per ______

 

________________________________________________________________________

Reason(s)forleaving_____________________

 

________________________________________________________________________

________________________________________________

 

____________________________________________________________________________

________________________________________________

 

__________________________________________________________________________

 

 

 

 

 

Didyousupervise?

Yes

No Ifyes,howmanyemployees?_____

Maywecontactthisemployer?

Yes

No

 

 

 

 

Employer____________________________________________________

From:_________________________________

 

Address_____________________________________________________

Month

Year

 

 

_______________________________________________________________

To:____________________________________

 

Supervisor’sNameandTitle ______________________________________

Month

Year

 

 

FullTime

PartTime

Volunteer

 

CompanyPhoneNumber _________________________________________

Averagehoursworkedperweek

____________

 

CompanyURLInternetAddress____________________________________

 

YourPositionTitleandDuties______________________________________

Starting Salary

$___________ Per ______

 

_______________________________________________________________________

Ending Salary

$___________ Per ______

 

________________________________________________________________________

Reason(s)forleaving_____________________

 

________________________________________________________________________

 

____________________________________________________________________________

________________________________________________

 

__________________________________________________________________________

________________________________________________

 

Didyousupervise?

Yes

No Ifyes,howmanyemployees?_____

Maywecontactthisemployer?

Yes

No

 

 

 

 

Employer____________________________________________________

From:_________________________________

 

Address_____________________________________________________

Month

Year

 

 

To:____________________________________

 

_______________________________________________________________

Month

Year

 

 

Supervisor’sNameandTitle ______________________________________

FullTime

PartTime

Volunteer

 

CompanyPhoneNumber _________________________________________

Averagehoursworkedperweek

____________

 

CompanyURLInternetAddress____________________________________

Starting Salary

$___________ Per ______

 

YourPositionTitleandDuties______________________________________

Ending Salary

$___________ Per ______

 

_______________________________________________________________________

Reason(s)forleaving_____________________

 

____________________________________________________________________________

________________________________________________

 

__________________________________________________________________________

________________________________________________

 

Didyousupervise?

Yes

No Ifyes,howmanyemployees?_____

Maywecontactthisemployer?

Yes

No

 

 

 

 

 

 

 

 

 

 

StateofHawai‘iDepartmentofHumanResourcesDevelopment

Page 4

FormHRD278(Rev.10/2013)

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