HRO Supplemental Questions

Position Applied For

Position

Notification Preference

USPS Mail

My Information

Legal First Name

Legal Middle Name

Legal Last Name

Street Address

City

State

Zip Code

Home Phone

Alternate Phone

Supplemental Questions (1-22)

1. Citizenship Status

The requirement for Citizenship must be met at the time of application.

U.S. Citizen

U.S. National (includes persons born in American Samoa, including Swain's Island)

Permanent Resident Alien

Non-Citizen authorized under federal law to work in the U.S.

2. Work Authorization

If you selected Non-Citizen, are you authorized to work in the U.S. without restrictions and/or employer sponsorship?

Yes

3. Please Explain

If you answered "Yes" or "No" to Question #2, please explain.

4. Other Names Used

Have you used another name in the past? (Include maiden name, nicknames, etc.)

Yes

5. List Other Names

(List names by Last, First, and Middle Initial, separated by semi-colon. If none, leave blank.)

6. Veteran's Preference

Veteran's preference points are only awarded for periods and conditions authorized by law. Requirements for veteran's preference must be met at the time of application. Are you claiming veteran's preference?

Yes

7. Veteran's Options

If you answered "Yes", you must submit, within 7 days of filing this application, the required documents to substantiate your claim. Mail or drop off your documents to: Department of Human Resources, 650 South King Street, 10th Floor, Honolulu, HI 96813. Copies will not be returned. Please select from the following options:

I am claiming 5 veteran's preference points, and will mail or drop off a copy of my DD214.

I am claiming 10 veteran's preference points, and will mail or drop off a copy of my DD214 and an official statement from the Veteran's Administration or armed forces, dated within the past 12 months which confirms my eligibility for 10 points preference. (Spouses or widows/widowers applying for preference must also submit appropriate documentation.)

I am claiming 10 vetreran's preference points as a Purple Heart recipient, and will mail or drop off a copy of my DD214.

8. Suitability Review

To determine the selectee's employment suitability, the Department of Human Resources will conduct an evaluation of personal suitability.

Convictions, dismissals from employment or dishonorable separations from military service do not automatically disqualify you for employment. To determine employment suitability, the circumstances of each individual case will be evaluated in relationship to the requirements of the position for which you have applied.

Your answers in Questions 9-22 will be reviewed to determine your suitability for employment.

Acknowledgement: I understand that any misstatements or omissions of material facts, as part of my appliciation, are cause of forfeiture of all rights to any employment in the service of the City and County of Honolulu.

9. Barred from Applying for Employment

Have you accepted a settlement or been barred from applying for employment with the City and County of Honolulu?

Yes

10. Please Explain

If you answered "Yes", please explain in detail the reason and date of your settlement or restriction from applying with the City. (Character limit: 500)

11. Controlled Substances

Within the past three years, have you been convicted of any offense related to controlled substances?

Yes

12. Please Explain

If you answered "Yes", include the dates, nature and circumstances of the conviction; the sentence imposed and its current status; and any other relevant information you wish to provide. (Character limit: 500)

13. Overthrow of Government

Have you ever been convicted of any act, attempt, or conspiracy to overthrow the State or Federal government by force or violence?

Yes

14. Please Explain

15. Conviction for Violation of Law

Convictions will not necessarily be a bar of employment. Factors such as age at the time of the offense, date of the offense, seriousness and nature of the violation, and rehabilitation may be taken into account.

In answering this question, you need NOT report the following:

1. Arrests not followed by convictions;
2. Convictions which were annulled or expunged;
3. Offenses for which you were tried as a minor or juvenile;
4. Convictions of offenses punishable by fine only (You must report any convictions that could have resulted in a jail sentence even if your sentence was only a fine. If you are in doubt, please answer "Yes" and explain in the following question #16.); and
5. Convictions of which a period of 10 years has elapsed since the date of the sentence was fulfilled and during which elapsed time there has NOT BEEN any subsuequent arrest or conviction.

What you MUST report:

1. State, out-of-state, federal, military, international, and other convictions; and
2. Convictions of FELONY and MISDEMEANOR offenses (including PETTY MISDEMEANOR, DUI, CONTEMPT OF COURT, etc.)

Have you been convicted of a violation of law?

Yes, I have petty misdemeanor/misdemeanor conviction(s).

Yes, I have contempt of court and/or DUI conviction(s).

Yes, I have felony conviction(s).

No, I do not have any criminal conviction(s).

16. Please Explain

17. Dismissal from Employment

Have you been fired, dismissed, discharged or asked/forced to resign from employment?

Yes

18. Please Explain

If you answered "Yes", please explain in detail the reason and date of your dismissal, discharge or resignation. (Character limit: 500)

19. Military Service

Have you been separated from military service under OTHER than honorable conditions?

Yes

I was never in the military

20. Please Explain

If you answered "Yes", please explain in detail the reason for and the date of your separation from military service. (Character limit: 500)

21. Suspension, Revocation, or Non-Renewal of License

Was your license or certification to practice in a regulated profession (for example, physician, engineer, nurse, plumber, etc.) ever suspended, revoked, or not renewed for cause?

Yes

22. Please Explain

If you answered "Yes", please indicate the type of license; the date; the State; the specific board or organization that suspended, revoked, or did not renew for cause, your license; the circumstances of the suspension, revocation, or non-renewal; and any other relevant information you wish to provide. (Character limit: 500)

Supplemental Questions (23-27)

23. Referral Source

How did you first find out about this examination?

City and County Employee(s)

School Counselor

Friend

City Website

Facebook

Twitter

Job Quest Job Fair

News Media

Honolulu Star-Advertiser

Oahu Work Links

I prefer not to answer this question

Other

24. Referral Source Follow-Up

If you selected "Other", how did you find out about this examination?

25. Internet Sources

Which internet site(s) do you frequently use to search for jobs? (Check all that apply)

I do not use the internet to search for jobs

CareerBuilder.com

City Website

Hawaii News Now - Job Link Now

HawaiiJobEngine.com

HireNet Hawaii

Indeed.com

LinkedIn.com

Monster.com

I prefer not to answer this question

Other

26. Internet Source Follow-Up

If you selected "Other", how did you find out about this examination?

27. Application Location

At what location did you apply for this examination?

City Department of Human Resources' computer kiosk

Department of Parks and Recreation District Office

Home

Oahu Work Links

Public Library

I prefer not to answer this question

Other

Supplemental Questions (28-31)

28. Test Accommodation

Test accommodations will only be granted for conditions that are required by law (e.g. disability, religious beliefs).

If you answered "Yes", you must submit, within 7 days of filing this application, your request in writing with supporting documents for an accommodation to be considered. Mail or drop off: Department of Human Resources, 650 South King Street, 10th Floor, Honolulu HI 96813.

Do you wish to request a test accommodation?

Yes

29. Geographic Job Location and Availability (Job Type)

Most positions are located in the Honolulu area and are permanent, full-time, forty hours per week, with 7:45 a.m. - 4:30 p.m. work schedule. I am available to work in the following areas (check all areas that you are willing to accept work in):

Honolulu (includes Halawa)

Kailua

Waimanalo

Kaneohe

Hauula/Kahuku

Waialua

Wahiawa/Mililani

Aiea/Pearl City

Waianae

Waipahu/Ewa/Kapolei

30. Job Availability

I am available for (check all that apply):

Permanent

Temporary

Part-time

31. Mandatory Acknowledgement Notice for Applicants

All applicants are required to read and acknowledge the following informational statement:

ACKNOWLEDGED: All applicants who are retirees of the State of Hawaii including the Department of Education, University of Hawaii, Judiciary, Hawaii Health Systems Corporation, City and County of Honolulu (City), County of Hawaii, County of Maui or County of Kauai receiving a retirement from the Hawaii State Retirement System (ERS) are advised that their re-employment with the City is subject to the provisions of Act 179, Session Laws of Hawaii 2010.

A break of at least six months is required before being re-employed. Even if you have had a break, you must be willing to stop your retirement and medical benefits to be re-employed. If you did not have a break, you will have to pay back your retirement plus penalties and interest.

Check with the Employees' Retirement System if you are unsure if working will jeopardize your retirement.

Supplemental Questions (32-34)

Applicant Data Survey

In order to meet the requirements as set forth in Federal guidelines, we need your cooperation and assistance in completing the following questions. PARTICIPATION IS CONFIDENTIAL AND VOLUNTARY. Your replies will not affect your eligibility or opportunity for employment. The data will be used for reporting and personnel research purposes only. It will not be used for the purpose of selecting job applicants.

ACKNOWLEDGED: My participation in the Applicant Data Survey is confidential and voluntary.

32. Sex (Optional)

Female

Male

33. Age (Optional)

1 - Under 20

2 - 20-24

3 - 25-29

4 - 30-39

5 - 40-49

6 - 50 and over

34. Ethnicity (Optional)

Read the categories below, then check the one which best fits your ethnic background.

American Indian or Alaska Native

Black/African American

Chinese

Filipino

Hispanic/Latino

Japanese

Korean

Native Hawaiian

Part-Hawaiian

Puerto Rican

Samoan

White (not of Hispanic origin) - Persons having origins in Europe, the Middle East or North Africa.

Other Pacific Islander - Persons having origins in any of the South Pacific islands, excluding Hawaii and Samoa.

Other Asian - Persons having origins in the Far East, Southeast Asia, or the Indian subcontinent, excluding China, Korea, Philippine Islands, and Japan.

Other/Unknown - Persons who do not identify with any of the categories listed.

References (optional)

Reference #1

Name

Position

Address

(Include Street, City, State, and Zip Code)

Phone

Reference #2

Name

Position

Address

(Include Street, City, State, and Zip Code)

Phone

Reference #3

Name

Position

Address

(Include Street, City, State, and Zip Code)

Phone

Attachments

Resume

Cover Letter

Certification of Application

Applicant Certification

I HEREBY CERTIFY that all statements made on or in connection with this application including those regarding my education and employment record are true and correct to the best of my knowledge. I agree and understand that any misstatements or omissions of material facts may cause forfeiture on my part of all rights to any employment in the service of the City and County of Honolulu. I understand that all information is subject to verification.

Further, I understand that I may be required to pass a drug screening test, and that applications and attachments become the property of the City Department of Human Resources and will not be returned. Also I will keep a copy of this application to bring with me to the interview.

Applicant Name

To complete your application, enter your FULL LEGAL NAME.

Application Date

Security Code