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6/30/11 3:05 PM
Please read the Print Margin Setting instructions Confirmation Code: GB27J5WA22
Application for Employment
Equal Opportunity Employer
Last Office worked last Tax Season:
H&R Block is an equal opportunity employer and considers all persons for employment regardless of race, color, religion, gender, national origin, age, disability, veteran status, sexual orientation, martial status, or status in any group protected by federal, state, or local law. No question on this application is intended to secure information to be used for discriminatory purposes. This application will be considered only for positions indicated below, providing the positions are open at time of application submission. Receipt of this application does not imply that the applicant will be employed. H&R Block hires only United States citizens and aliens lawfully authorized to work in the United States. All new associates will be required to certify that they are eligible for employment in the United States. All fields marked as * are required fields
Position Applying For In the drop down, you will find the current positions available for applications. Please select the title of the position for which you wish to apply. You may click on the job summary for a brief description of the positions available. *Position
Pre-Season Tax Service
Personal Information Date: 06/30/2011 Please enter your full legal name, as it appears on your Social Security card.
*It is critical that the full legal name entered below matches exactly to the name on your Social Security Card, to ensure that all wages are able to be posted to your Social Security Account.
*First Name: A waheedah
To verify employment and educational history, please provide any other names used: Preferred First Name: Waheedah
Your home address will be used for all mailings, unless a separate mailing address has been provided. Please review / enter / update your address information in the spaces provided below. Prior associates, please note: any changes to your address information via this application will be used to automatically update Self Service.
Home Address: *Street: 2021 Brooks Drive *City: District Heights
Apartment: 825 *State:
*Zip Code: 20747
We use the home address for mailings. If you would like for us to direct mailings to a different address, please check here:
Page 1 of 8
00PM https://ahp.hrblock.00PM Please indicate the Peak hours and days you will be available.00AM 06.Printing Application 6/30/11 3:05 PM Street: 2021 Brooks Drive City: District Heights Apartment: 825 State: Maryland County: PRINCE GEORGES Zip Code: 20747 Contact details *One phone number required: Home Telephone Number: 651 808 Alternate Phone Number: 7616 Business Telephone Number: 651 808 7616 * Email Address: awaheedah.00PM Wednesday 10.00PM Tuesday 10.00AM 06.00AM email@example.com. Peak usually starts the last week in January and goes through the middle of February.00PM Thursday Friday 10.00AM 06.00AM 05.00AM 06.00AM 06.00PM Tuesday 10.00PM Monday 10.00PM Wednesday Thursday Friday 10. *At least one day must be filled. Saturday From To Sunday 10.com Have you ever worked for H&R Block? Yes No SSN: 02407 For assistance setting up an email address please contact (877)659-8854 H & R Block Employee ID: 474811 Work Location The Office where you preferred to submit your application: * Office ID: 19585 Office Address: Availability *Date you are available to start work 07/11/2011 Please indicate the Non Peak hours and days you will be available. April Peak is generally the 10th through the last filing date.00AM 06. Saturday From To Sunday 10.00AM 05.com/PrintApplication?confirmId=GB27J5WA22 Page 2 of 8 .00PM Monday 10.
For positions that require travel between offices: *Do you have transportation available for business use? *If transportation is your personal car.50 Finish $ 11. TO BE COMPLETED IN FULL-Incomplete applications will not be accepted DATES *Name and address of employer (Include City and State) Rate of Pay *Start $ 10 *Finish $ 10 *May we contact? Yes No *From 01/04/2010 H R Block 22630 University Ave *Supervisor's name.Printing Application 6/30/11 3:05 PM Availability Comments I am willing to work extra hours andor days with prior notice requested. do you carry liability insurance that meets the state minimum requirements? *Are you aware this is a seasonal position? *Are you willing to work evening and weekend hours? *Are you willing to work fluctuating hours each week? No No No No No Yes Yes Yes Yes Yes Prior Work History.50 May we contact? Yes No From 01/01/2009 H R Block 22631 Seeger Square Supervisor's name.com/PrintApplication?confirmId=GB27J5WA22 Page 3 of 8 . Please begin with your present or most recent employment.hrblock. title and phone number Gary ArnettDM William LynchOC KristenDM Harold KingsburyOC Scott Holmblad DM651-301-1760 *Title of last position held Tax Specialist ll Office Coordinator *To 04/23/2010 *Commission or Bonus? Yes No *Describe briefly the work you did : Tax Professional Bonus Amount : $ *Reason for leaving : state relocation DATES Name and address of employer (Include City and State) Rate of Pay Start $ 11. title and phone number Gary ArnettDM William LynchOC KristenDM Harold KingsburyOC Describe briefly the work you did : Tax Professional Title of last position held Tax Specialist ll Office Coordinator To 04/24/2009 Commission or Bonus? Yes No Bonus Amount: Reason for leaving : https://ahp.
Printing Application 6/30/11 3:05 PM currently employed $ DATES Name and address of employer (Include City and State) H R Block 39 W 7th Street Start $ 11. 1 https://ahp.00 Maywe contact? Yes No From 01/03/2011 H R Block 14756 Main Street Supervisor's name. title and phone number Doug Centeno Title of last position held Tax Specialist ll To 04/18/2011 Commission Bonus : Yes No Describe briefly the work you did : Tax Professional Bonus Amount: $ Reason for leaving : seasonal employment Education and Training *Name and location of educational institution (including city and state) Business Voc.hrblock. MN.00 Finish $ 10. title and phone number Gary ArnetDM William LynchOC KristenDM A. Waheedah AkbarShabazzOdiachiOC Describe briefly the work you did : Tax Professional Title of last position held Tax Specialist ll Office Coordinator To 04/25/2007 Commission or Bonus : Yes No Bonus Amount: $ Reason for leaving : currently employed DATES Name and address of employer (Include City and State) Rate of Pay Start $ 10. ST. Graduated Number of years attended Degree certificat Course or major study Nursing Assistant Page 4 of 8 TRAINING INSTITUTE OF MINNESOTA INC.50 Rate of Pay Finish $ 11.com/PrintApplication?confirmId=GB27J5WA22 . PAUL. Tech.50 Maywe contact? Yes No From 12/01/2005 Supervisor's name.
ILLINOIS KISHWAUKEE COMMUNITY MALTA. College Business Voc.. the words "convicted" and "conviction" include guilty pleas of "nolo contendre" or "no contest". or statutorily eradicated. MS Excel : Power Point: Proficient Proficient Proficient N/A Internet useresearch : Typing Skill : Information Technology Skills Hardware : Bilingual/Multilingual Skills *Please list your current language skills and proficiencies starting with the most proficient below: Not Applicable None Programming languages : Operating systems : Disclosure Instructions Hawaii Applicants: Do not answer the criminal history section. https://ahp. Securities.Printing Application 6/30/11 3:05 PM Graduate School Business Voc. If you question whether your conviction is excluded. This instruction applies to both felony and misdemeanor convictions. You may answer as if you have no record if: The record has been sealed. For these instructions. Please read the instructions carefully before answering questions regarding criminal history.g. Program Office Assist Sk Sheet Metal Apprentice General Education Computer Skills *Overall. You are responsible for accurately responding to questions about your criminal history. Juvenile Convictions: You are not required to disclose juvenile records.MN.hrblock.N. ILLINOIS 4 1 13 3 4 BBA MBA certificat certificat certificat Business Administration. expunged. experiences. and Construction Trades R. High School American InterContinental University CHICAGO WOMEN IN TRADES CHICAGO . certifications.com/PrintApplication?confirmId=GB27J5WA22 Page 5 of 8 . This includes convictions that are judicially dismissed or discharged prior to final adjudication of guilt. or Insurance training. Tax Courses. Tech. Your arrest resulted in a diversion program. provided that you satisfied all of the requirements of the diversion program. consult your own attorney. please rate your ability to use a computer: MS Word : MS Access : MS Outlook : 10 key : N/A Proficient Proficient Proficient Proficient Other Skills List any other education. California Applicants: You are not required to disclose any convictions for the possession of marijuana (except for convictions for the possession of marijuana on school grounds or possession of concentrated cannabis) that are more than two (2) years old. or skills related to the position(s) for which you have applied (if not already listed) e. Massachusetts Applicants: Do not answer the criminal history section. Your conviction was pardoned. BELLWOOD. Tech. IL KENWOOD ACADEMY CHICAGO. ILLINOIS LOCAL 10 LOCAL 73 JATC WBL.
under your name or another name. conviction does not automatically bar employment.hrblock. *Have you ever. please state the facts including dates of conviction: No Yes *Have you ever. For all other positions. but will be considered as it relates to fitness to perform the job). you must disclose all convictions that occurred within the last seven (7) years other than those excluded in the above instructions. conviction does not automatically bar employment.Suspension from or denial of participation in the program may automatically bar employment based upon Internal Revenue Service electronic filing program guidelines. but will be considered as it relates to fitness to perform the job) if yes. If you have been convicted of another offense within the last seven (7) years. Are you currently under suspension from the Internal Revenue Service electronic filing program? No Yes https://ahp. been convicted of (or pleaded guilty or nolo contendere to) a misdemeanor? (Securities laws and regulations dictate that certain convictions may be an automatic bar to employment. you must disclose all convictions that occurred within the last five (5) years other than those excluded in the above instructions. been convicted of (or pleaded guilty or nolo contendere to) a violation of any State or Federal Tax Laws ? (Conviction does not automatically bar employment. Misdemeanor Convictions Time Limits: You are not required to disclose any misdemeanor conviction that is more than five (5) years old unless you have been convicted of another offense during the last five (5) years. For all other positions. please state the facts including dates of conviction: No Yes *Are you currently on probation or parole? if yes.com/PrintApplication?confirmId=GB27J5WA22 Page 6 of 8 .Printing Application 6/30/11 3:05 PM Misdemeanor Convictions: If you are applying for a position that will require driving. you must disclose any conviction for driving under the influence. if yes. been convicted of (or pleaded guilty or nolo contendere to) a felony? (Securities laws and regulations dictate that certain convictions may be an automatic bar to employment. Felony Time Limits: You are not required to disclose any felony conviction that is more than seven (7) years old. Disclosures Please ensure you have read the above Criminal History Disclosure Instructions prior to completing the following questions. please state the facts including dates of conviction: No Yes *Have you ever. All circumstances will be considered as they relate to the position for which you are applying. please state the facts including dates: No Yes *Some positions require acceptance in the Internal Revenue Service electronic filing program as a condition of employment. but will be considered as it relates to fitness to perform the job). if yes. under your name or another name. under your name or another name. If you have been convicted of another offense within the last five (5) years.
the information given in this application is true and correct.com/PrintApplication?confirmId=GB27J5WA22 Page 7 of 8 . Authorization I certify that.Printing Application 6/30/11 3:05 PM if yes. *I agree to the statement(s) of the authorization above https://ahp.hrblock. except those whom I have indicated to exclude. please indicate if you are under the age of 18? *Are you currently legally authorized to work in the United States? *How were you referred to H&R Block? *Is any member of your family employed by H&R Block or any of its subsidiaries.I understand that any omission or misrepresentation of material fact on this application may result in refusal or termination of employment. including RSM McGladrey? If yes. I will comply with all rules and regulations set forth and communicated to associates by the Company. please provide the following information: Name: Corporation: Position/Title: Department: No No Yes Yes Former HR Block Associate No Yes Please provide any securities license(s) or securities and insurance/annuity license(s) and the firm they are licensed with. I hereby authorize H&R Block or any of its subsidiaries to investigate my qualifications with previous employers and other sources as necessary. please state the facts : No Yes Additional Information *In order to comply with laws for employment of minors under the age of 18. to the best of my knowledge. *I hereby authorize this electronic signature submittal to serve as my legal signature. or do you currently hold an Electronic Filing Identification number (EFIN) from the Internal Revenue Service? (Note: This is not your PTIN) No Yes *Have you ever been denied acceptance into the Internal Revenue Service electronic filing program? if yes. I understand that my employment is contingent upon my ability to certify and to show that I am eligible for employment in the United States.If employed. please state the facts: *Have you ever held.
hrblock.com/PrintApplication?confirmId=GB27J5WA22 Page 8 of 8 .Printing Application 6/30/11 3:05 PM Full Legal Name: Application will remain on file for a period of at least 90 days. https://ahp.
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