To apply for a position in our callcenter or warehouse, please fill out this questionnaire.

Personal Information

First NameMiddle Name

Last Name

Email Address

Street Address

City State Zip

Phone #Best Time To Call

Are you 18 or older? Yes No

Have you been known by another name? Yes No If yes, what?

Your interest in Heartland America

Departments

Call Center

Warehouse

Data Entry

Other:

Availibility

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 No If yes, when?

Have you worked at Heartland America before? Yes No If 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.

Employer

Telephone

Address

Supervisor's Name and Title

Employed FromTo

Describe the Work you did

May we contact this employer? Yes No

Explain your reasons for leaving

Employer

Telephone

Address

Supervisor's Name and Title

Employed FromTo

Describe the Work you did

May we contact this employer? Yes No

Explain your reasons for leaving

Employer

Telephone

Address

Supervisor's Name and Title

Employed FromTo

Describe the Work you did

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 Completed 1 2 3 4 5+

Did you graduate? Yes No

Course of Study

Degree 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.

Sales

Telemarketing - Inbound or Outbound

Retail

Upselling 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

When can you start?

If offered a position, when would you be able to start?

Immediately

Within 2 weeks

Within one month

More than one month