Membership Application Please complete the fields in the form below and then submit. We will review your application and contact you shortly. Member Application Personal Applicant Information Name * Present Employer * Industry * Mailing Address * City * State * VirginiaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Business Phone * Email * Professional Background Information Job Title * Classification Of Position * Exempt Non-Exempt Time in Current Position * Current Areas of Responsibility / Description of Duties * If less than (3) years in current position, list previous work experience Employer's Name Employment Dates Position Held Duties If a recent College Graduate, please list recent College Education Dates of Enrollment School Degree / Course of Study Are you a SHRM Member? * Yes No SHRM Membership Number * Forms of Accreditation PHR SPHR CCP CBP SHRM-CP SHRM-SCP Other Professional Reference (Please list an individual who can attest to the above information) Reference's Name * Title * Employer's Name * Phone * I hereby apply for membership in the Alamance County Human Resources Association, and certify that the information provided is correct to my knowledge. Signature * signature keyboard Clear Date * reCAPTCHA Submit If you are human, leave this field blank.
