Employment Application

(817) 625-4213

We greatly appreciate your interest in our organization and assure you that applicants are considered for all positions without regard to race, color, sex, age, religion, national origin, disability, marital, or veteran status. Please note this application must be completed in its entirety and signed, in order to be considered for employment. Information submitted on this application is subject to verification. NOTE: All new hires are required to submit documentation in accordance with the Immigration Reform and Control Act of 1986.

First

Middle

Last

Street Address

City

State

Zip

How long have you lived at this address?

Are you at least 18 years of age?

Yes No

If no, please state your age

Are you legally eligible for employment in the US?

Yes No

Employment Information

Position applying for:

Date available to start:

Referred By:

Type of employment desired:

Full Time Part-Time Temporary

Wage desired

Are you willing to work overtime, if required?

Yes No

Are there any shifts or hours that you cannot work?

Yes No

If yes, please identify:

Are you able and willing to perform job related functions with or without reasonable accommodation?

Yes No

Have you ever applied for a position with this Company before?

Yes No

If yes, When?

Have you ever been convicted of a felony or a misdemeanor?

Yes No

If yes, state the date and places where the charges occurred (Note: answering “yes” will not automatically disqualify you for employment):

Are you presently employed?

Yes No

If yes, may we contact your present employer?

Yes No

In the event of an Emergency, Notify:

Name

Address

Phone

Relationship

High School:

Years Completed

Did you graduate?

Yes No

Degree Earned

College:

Years Completed

Did you graduate?

Yes No

Degree Earned

Graduate School:

Years Completed

Did you graduate?

Yes No

Degree Earned

Trade, Business, or Correspondence School:

Years Completed

Did you graduate?

Yes No

Degree Earned

Please give an accurate and complete full/part time employment record. Start with your present or most recent employer first.

Company Name

Phone

Address

Employed From

Name of Supervisor

Starting Salary/Wages

End

Job title and responsibilities

Reason for leaving

Company Name

Phone

Address

Employed From

Name of Supervisor

Starting Salary/Wages

End

Job title and responsibilities

Reason for leaving

Company Name

Phone

Address

Employed From

Name of Supervisor

Starting Salary/Wages

End

Job title and responsibilities

Reason for leaving

Note that all the employers listed above will be contacted unless the applicant indicates differently

Are there any employers above whom you do not wish for us to contact?

Yes No

If yes, please indicate employer and reason:

List below the names of three persons, not related to you, whom you have known for at least one year.

Name

Address & Phone

Business

Years Known

Name

Address & Phone

Business

Years Known

Name

Address & Phone

Business

Years Known

Background Check Authorization for Consumer Reports

In connection with your application for employment (including contract for services), understand that consumer reports or investigative consumer reports which may contain public record information may be requested or made on you including consumer credit, criminal records, driving record, education, prior employer verification, workers’ compensation claims and others. These reports will include experience information along with reasons for termination of past employment. Further, understand that information from various Federal, State, local and other agencies which contain your past activities will be requested. A consumer report containing injury and illness records and medical information may be obtained only after a tentative offer of employment has been made. By signing below, you hereby authorize without reservation, any party or agency contacted by Hood Specialist, Inc. dba Facilitec Southwest to furnish the above-mentioned information. You further authorize ongoing procurement of the above-mentioned reports at any time during your employment (or contract). You also agree that a fax or photocopy of this authorization with your signature be accepted with the same authority as the original. You have the right to make a request upon proper identification and the payment of any legally permissible fees, for the information on you at the time of your request. You hereby authorize and request, without reservation, any present or former employer, school, police department, financial institution, division of motor vehicles, consumer reporting agencies, or other persons or regarding you, in order that your employment qualifications may be evaluated.

Agree to Consent

Yes No

Drivers License

Drivers State

I hereby reaffirm that I have read the foregoing questions and that my answers to them are true and correct and that I have not misrepresented or withheld any information. I understand that falsification of this information may be cause for immediate dismissal. I further acknowledge that my employment may be terminated, and the company or I may withdraw any offer of employment without prior notice. I also understand that my employment is at will. This means I am free to terminate my employment at any time, for any reason, and the company retains the same right. I understand that any offer of employment may be contingent upon a credit and criminal background investigation and a pre-employment drug screen. I hereby authorize all references and former employers listed on my employment application to give the company any and all information concerning my previous employment and any pertinent information they might have, personal or otherwise. I hereby release all parties, including agents, from any claims, causes of action, or liability from damages that may or could result from furnishing such information to the company or as a result of information obtained through a background investigation or drug screen.

Agree

Yes No