Application For Employment

Application For Employment
These instructions must be followed exactly. Fill out application form completely. If questions are not applicable, enter "NA." Do not leave questions blank. Be sure to sign when completed. The State of Texas is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services. Resumes will not be accepted in lieu of applications. This application becomes public record and is subject to disclosure.
Name*

First NameMiddle NameLast Name
Maiden Last Name*
List any other alternate name(s) used if different from name on this application:
Date of Birth (Required for Background Check)
Social Security Number (Required for Background Check)
Drivers License Number (Required for Background Check)
Current Physical Address (PO Box Not Allowed)*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Daytime Phone*

Area CodePhone Number
Work Phone (Optional)

Area CodePhone Number
List exact title of position or type of work and location for which you wish to apply:
Do you have any relatives working for this agency?*

YesNo
If yes, list names and relationships:
Position Applying for:*

Full-TimePart-TimeSummerTemp/ProjectIntershipOther
Date available for work:*

MonthDayYear
Date
Are you at least 17 years of age?*

YesNo
Are you willing to work hours other than 8:00am-5:00pm*

YesNo
What days are you unable to work?
Are you willing to travel?*

YesNo
If yes, what percent of time?
Current Driver's License # (if required for the position) *
State / Number
Commercial Drivers License*

YesNo
Geographic Preference*
City / Area
Have you ever been convicted of a felony or subjected to deferred adjudication on a felony charge?*

YesNo
If your answer is "Yes," explain in concise detail, giving dates and nature of the offense, name and location of the court, and disposition of the case(s). A conviction may not disqualify you, but a false statement will.
Education

NOTE: Applicants may be required to provide proof of diploma, degree, transcripts, licenses, certifications, and registrations.
High School Graduate or GED?*

YesNo
If yes, name and location of high school or GED Institute:
Undergraduate Colleges or Universities - Name School, Dates Attended, Date of Graduation/Expected Date of Graduation, Type of Diploma/Degree, Major/Minor Fields of Study.
Graduate Schools - Name School, Dates Attended, Date of Graduation/Expected Date of Graduation, Type of Diploma/Degree, Major/Minor Fields of Study.
Technical or Vocational Schools - Name School, Dates Attended, Date of Graduation/Expected Date of Graduation, Type of Diploma/Degree, Major/Minor Fields of Study.
License/Certification

If a license, certificate, or other authorization is required or related to the position for which you are applying, complete the following:
Name of License/Certification, Date Issued, Date Expires, Issued by (State or other authority)/Location of Issuing Authority (City&State). List all below:
Special Training/Skills/Qualifications: List all job related training or skills you possess and machines or office equipment you can use, such as calculators, printing or graphics equipment, computer equipment, types of software and hardware.
Approximately how many words per minute do you type?
Sign Language (If required for this position):*

YesNo
Are you a certified interpreter?*

YesNo
Do you speak a language other than English? (If required for this position)*

YesNo
If yes, what language(s) do you speak and how fluently (Fair, Good, or Excellent)?
Do you write in a language other than English? (If required for this position)*

YesNo
If yes, what language(s) do you write and how fluently (Fair, Good, or Excellent)?
Former Foster Youth

Verification may be required
Were you a foster youth under the Texas Department of Family and Protective Services on the day before your 18th birthday?*

YesNo
If yes, are you currently 25 years of age or younger?*

YesNoNot Applicable
Military Service

A copy of a report of separation from the Armed Services may be required
Are you a veteran?*

YesNo
If yes, list type of discharge:
Dates of Service (From/To):
Are you a surviving spouse of a veteran who has not remarried?*

YesNo
Are you a surviving orphan of a veteran?*

YesNo
If yes, complete dates of service for veteran
Employment History

This information will be the official record of your employment history and must accurately reflect all significant duties performed. Summaries of experience should clearly describe your qualifications.
Include ALL employment. Begin with your current or last position and work back to your first. Employment history should include each position held, even those with the same employer.
EMPLOYER ADDRESSES MUST BE COMPLETE MAILING ADDRESSES, INCLUDING ZIP CODE.
Answer all questions and completely summarize your experience including technical and managerial responsibilities and any special training, skills and qualifications for each position you have held. If you need additional space to adequately describe your employment history, attach a typed employment history providing the same information in the same format as this application form.
Position 1 Title:
Employer/Business Name:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Phone:

Area CodePhone Number
Immediate Supervisor Name/Title:
Immediate Supervisor Phone:

Area CodePhone Number
Average Number of Hours worked per week:
Was the position:

Full-TimePart-TimeSummerTem/ProjectInternship
Starting Date:

MonthDayYear
Date
Leaving Date:

MonthDayYear
Date
Current/Final Salary:
Position Type:

TechnicalNon-ManagerialSupervisory/ManagerialOther
If supervisory, number of employees you supervised:
Summary of experience including special training/skills/qualifications you have used in the performance of this job and your specific reason for leaving:
Position 2 Title:
Employer/Business Name:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Phone:

Area CodePhone Number
Immediate Supervisor Name/Title:
Immediate Supervisor Phone:

Area CodePhone Number
Average Number of Hours worked per week:
Was the position:

Full-TimePart-TimeSummerTem/ProjectInternship
Starting Date:

MonthDayYear
Date
Leaving Date:

MonthDayYear
Date
Current/Final Salary:
Position Type:

TechnicalNon-ManagerialSupervisory/ManagerialOther
If supervisory, number of employees you supervised:
Summary of experience including special training/skills/qualifications you have used in the performance of this job and your specific reason for leaving:
Position 3 Title:
Employer/Business Name:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Phone:

Area CodePhone Number
Immediate Supervisor Name/Title:
Immediate Supervisor Phone:

Area CodePhone Number
Average Number of Hours worked per week:
Was the position:

Full-TimePart-TimeSummerTem/ProjectInternship
Starting Date:

MonthDayYear
Date
Leaving Date:

MonthDayYear
Date
Current/Final Salary:
Position Type:

TechnicalNon-ManagerialSupervisory/ManagerialOther
If supervisory, number of employees you supervised:
Summary of experience including special training/skills/qualifications you have used in the performance of this job and your specific reason for leaving:
Position 4 Title:
Employer/Business Name:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Phone:

Area CodePhone Number
Immediate Supervisor Name/Title:
Immediate Supervisor Phone:

Area CodePhone Number
Average Number of Hours worked per week:
Was the position:

Full-TimePart-TimeSummerTem/ProjectInternship
Starting Date:

MonthDayYear
Date
Leaving Date:

MonthDayYear
Date
Current/Final Salary:
Position Type:

TechnicalNon-ManagerialSupervisory/ManagerialOther
If supervisory, number of employees you supervised:
Summary of experience including special training/skills/qualifications you have used in the performance of this job and your specific reason for leaving:
References
Reference 1 Name

First NameLast Name
Reference 1 Phone Number

Area CodePhone Number
Reference 1 Email
example@example.com
Describe relationship/work history with Reference 1
Reference 2 Name

First NameLast Name
Reference 2 Phone Number

Area CodePhone Number
Reference 2 Email
example@example.com
Describe relationship/work history with Reference 2
Reference 3 Name

First NameLast Name
Reference 3 Phone Number

Area CodePhone Number
Reference 3 Email
example@example.com
Describe relationship/work history with Reference 3
Resume Upload

Attach a copy of your resume in PDF format:
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Harvest House Code of Ethics:
- Our staff will exhibit the highest ethical best practices and personal integrity.
- Our staff will provide a professional work environment that is free from physical, psychological, written, or verbal intimidation or harassment.
- Our staff will not physically, sexually, or emotionally abuse or neglect a youth or adult.
- Our staff will share concerns about suspicious or inappropriate behavior with their supervisor.
- Our staff will report any suspected abuse or neglect of a youth to the state authorities.
- Our staff will accept their personal responsibilities to protect youth and adults from forms of abuse.
Please sign your first and last name if you agree to the Harvest House Code of Ethics

First NameLast Name
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND INDICATE YOUR UNDERSTANDING AND ACCEPTANCE BY SIGNING IN THE SPACE PROVIDED
I certify that all the information provided by me in connection with my application, whether on this document or not, is true and complete, and I understand that any misstatement, falsification, or omission of information may be grounds for refusal to hire or, if hired, termination.

I understand that as a condition of employment, I will be required to provide legal proof of authorization to work in the U.S.
I understand that the State of Texas requires all males who are 18 through 25 and required to register with the Selective Service, to present either proof of registration or exemption from registration upon hire.
I understand that some state agencies will check with the Texas Department of Public Safety, the Federal Bureau of Investigation or other organizations, for any criminal history in accordance with applicable statutes.
I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability from any damages which may result from furnishing such information to you.

THIS APPLICATION MUST BE SIGNED
Date

MonthDayYear
Date
Employee Signature

Clear
Should be Empty:

Application For Employment

Education

License/Certification

Former Foster Youth

Military Service

Employment History

References

Resume Upload

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND INDICATE YOUR UNDERSTANDING AND ACCEPTANCE BY SIGNING IN THE SPACE PROVIDED