Independence Village

Independence Village

Employment Application
The Independence Village is an Equal Opportunity Employer committed to excellence through diversity. Employment offers are made on the basis of qualifications and without regard to race, color, national origin, sex, religion, age, disability or any other legally protected status.
Application Information
Today's Date *

Month Day Year
Date
First *
Middle *
Last *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone *
Email *
example@example.com
List any other names used in the past: (Maiden name, alias etc.)
Social Security No. *
Salary Expectation *
Desired Position *
Full or Part Time *

FT PT
Date available to begin *

Month Day Year
Date
Are you 18 years of age or older? *

YES NO
Are you currently employed? *

YES NO
Are you on a "lay-off" status & subject to recall? *

YES NO
Can you travel if a job required it? *

YES NO
Have you ever filed an application with us before? *

YES NO
If yes, when:

Month Day Year
Date
Have you ever worked with us before? *

YES NO
If yes, when:

Month Day Year
Date
Are you authorized to work in the U.S. Proof of citizenship or immigration status will be required upon employment. *

YES NO
Have you ever been convicted of a felony? *

YES NO
If your answer is "Yes," please explain below: A conviction may not disqualify you, but a false statement will.
Education
High School
Address
From
To
Did you graduate?

YES NO
Diploma
College
Address

Address
From
To
Did you graduate?

YES NO
Degree
Other
Address

Address

Street Address Line 2
From
To
Did you graduate?

YES NO
Degree
Skills
List Professional, Trade, Business or Civic Activities and Offices Held:
Describe any specialized training, apprenticeship, skills and extra curricular activities
Military Service
Branch
From
To
Rank at Discharge
Type of Discharge
If other than honorable, explain
Describe any job related training
Previous Employment
Company
Phone
Supervisor
Address
Job Title
Starting Salary:$
Ending Salary
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

YES NO
Company
Phone
Supervisor
Address
Job Title
Starting Salary:$
Ending Salary
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

YES NO
Company
Phone
Supervisor
Address
Job Title
Starting Salary:$
Ending Salary
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

YES NO
References

Please list three professional references.
Full Name
Title
Email
example@example.com
Phone
Full Name
Title
Email
example@example.com
Phone
Full Name
Title
Email
example@example.com
Phone
Disclaimer and Signature
PLEASE READ CAREFULLLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.

I certify that the information on this application and its supporting documents is accurate and complete. I understand that any misstatement, falsification, or omission of information may be grounds for refusal to hire or, if hired, termination. 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. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. I understand that I am required to abide by all rules and regulations of the employer.
Signature *

Clear
Pre-Employment Drug Screen Consent
I understand that the Independence Village is a drug free workplace and I hereby voluntarily consent for a urine or hair sample to be collected from me and submitted for a drug screening test. Further, I consent to the release of the test results for confidential review and use in determining my suitability for employment. I understand that any positive test results may preclude my employment.
Signature *

Clear
Criminal Background Check Form
Independence Village - Human Resources

With few exceptions, you are entitled on your request to be informed about the information Independence Village collects about you. Under sections 552.023 of the Texas Government Code, you are entitled to receive and review the information. Under Section 559.004 of the Texas Government Code, you are entitled to have Independence Village correct information about you that is held by us and is incorrect. The information that Independence Village collects will be retained and maintained as required by Texas records retention laws (Section 441.180 et seq. of the Texas Government Code) and rules. Different types of information are kept for different periods of time.

THIS SECTION TO BE COMPLETED BY APPLICANT/VOLUNTEER

IMPORTANT: Fill out all information requested. If not applicable, enter N/A. Falsification of any information on this form will void your application for employment and any actions based on it. The information on the Application for Employment, including attachments, is the property of Independence Village.
First *
Middle *
Last *
Maiden
List any former names used
Social Security No. *
Gender *

Male Female
Date of Birth *

Month Day Year
Date
Height
List all previous out-of-state addresses and dates of residency:
Do you have any criminal convictions since age 17 or older or any deferred adjudications where the final disposition is still pending (i.e. the original charge has not been dismissed)? *

YES NO
If yes, list year(s) of conviction(s) and nature of offense(s) and penalty(ies)
CONVICTION IS NOT AN AUTOMATIC BAR TO EMPLOYMENT - ALL CIRCUMSTANCES WILL BE CONSIDERED

I hereby authorize any law enforcement agency to furnish Independence Village information related to my criminal history. I hereby release Independence Village and employees, the law enforcement agency, and all employees of law enforcement agencies furnishing information from all liability resulting from furnishing of this information to Independence Village. I certify the statements made by me on this form are true, and complete and correct to the best of my knowledge and belief and are made in good faith. If circumstances require that an offer be made before the completion of an investigation, the offer is contingent on the completion of a satisfactory criminal background investigation. I understand that any false statements made herein will void my Application for Employment or Volunteerism and any actions based on it.
Signature *

Clear
Should be Empty:

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Application Information

Education

Skills

Military Service

Previous Employment

References

Disclaimer and Signature

Pre-Employment Drug Screen Consent

Criminal Background Check Form