Your Happy Family

936.295.7038

Application for Employment

GENERAL

Position(s) applied for *
Date of application *

MM 		/
DD 		/
YYYY

Personal Information

Name *

First
Last
Social Security Number *
Address *

Street Address

City
State / Province / Region

Postal / Zip Code
Country
Telephone Number *

### 		-
### 		-
####
Mobile/Other Phone Number

### 		-
### 		-
####
E-mail Address
If you are under 18, and it is required, can you furnish a work permit? *
 Yes 
 No 
If no, please explain
Have you ever been employed here before? *
 Yes 
 No 
If yes, provide dates and positions
Are you legally eligible for employment in this country? *
 Yes 
 No 
Date available for work *

MM 		/
DD 		/
YYYY
What is your desired salary range? *
Type of employment desired *
 Full-time 
 Part-time 
 Temporary 
 Seasonal 
 Educational 
Are you able to meet the attendance requirements of the position? *
 Yes 
 No 
Have you ever pled "guilty” or “no contest” to or been convicted of a crime? *
 Yes 
 No 
If yes, please provide the date(s) and details
Answering yes to these questions does not constitute and automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Driver’s license number, if driving is an essential job function
Driver’s license state of issue

SKILLS & QUALIFICATIONS:

Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job related functions in the position for which you are applying.

EDUCATION:

Name & Location - Number of Years Completed - Did You Graduate? *

EMPLOYMENT HISTORY:

Present or Last Position:
Start Date *

MM 		/
DD 		/
YYYY
End Date *

MM 		/
DD 		/
YYYY
Employer: *
Position Title: *
Supervisor: *
Address: *
Phone Number *

### 		-
### 		-
####
Responsibilities: *
Salary *
Input hourly wage, if not salaried.
Reason for Leaving: *
May We Contact for Reference?
 Yes 
 No 

Previous Position
Start Date

MM 		/
DD 		/
YYYY
End Date

MM 		/
DD 		/
YYYY
Employer:
Position Title:
Supervisor:
Address:
Phone Number

### 		-
### 		-
####
Responsibilities:
Salary
Input hourly wage, if not salaried.
Reason for Leaving:
May We Contact for Reference?
 Yes 
 No 

REFERENCES:

Name - Telephone - Number of Years Known *

APPLICATION STATEMENT

I certify that all information I have provided is in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me with this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives seeking gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or exercising an application from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to re-apply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that to implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United states and that federal immigration laws require me to complete an I-9 Form in this regard.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. *
 Yes, I agree. 
Signature of Applicant *
Please provide an electronic signature by typing your name in the box above.
Image Verification
captcha
Please enter the text from the image:
[Refresh Image] [What's This?]