HRACC Membership Application | Human Resource Association of Centre County

Applicant Name: *

Title: *

Current Employer: *

Business Address: *

Telephone Number: *

Fax Number:

Email Address: *

Brief Description of Business:

Number of Years with above Employer:

Number of Employees at Your Location:

Number of Employees at All Locations:

Describe Your Primary HR Duties and Responsibilities:

Number of Employees You Directly Supervise:

Previous Employer:

Number of Years in the HR Profession: *

1 to 5

6 to 10

11 to 20

Greater than 20

Does your organization have a union?: *

Yes

No

Is your organization publically held?: *

Yes

No

Does your organization handle federal contracts?: *

Yes

No

Are you a member of the Society for Human Resource Management(SHRM)?: *

Yes

No

SHRM Membership Number:

Date Initially Certified:

Expiration Date:

Will you be the principal representative for your company?: *

Yes

No

If not, who is the principal representative?:

Sponsor’s Name (must be a current member if applicable):

Applicant’s Signature (type name): *

Date: *