| Address: |
No. & Street
_________________ |
City
__________________ |
State/Zip
___________________ |
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| Social Security #:________________________ |
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| Home Phone: (___) ___-____ |
Cell Phone: (___) ___-____ |
Emergency: (___) ___-____ |
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Position for which you are applying:
___________________ |
Minimum Salary Requirement:
________________ |
Date Available for work:
__________________ |
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| Check the following options you would consider: |
|
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____Full Time |
____ Part-time |
____ Temporary |
____Summer |
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| If part-time, specify hours/days you are available to work: _______________ |
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| Have you ever worked for The Woodlands Community Service Corporation/The Woodlands Fire Department, Inc.? Yes(_) No(_) |
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| When _________________________________ |
Which Department _________________________________ |
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General Information
| How did you learn about The Woodlands Community Service Corporation/The Woodlands Fire Department, Inc? |
| |
Advertisement ________ |
Web site/Internet ________ |
Walk-in _________ |
Other ________ |
| |
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| Referred by WCSC/WFD employee ________ |
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| Can you, after employment, submit verification of your legal right to work permanently in the U.S.? ___Yes ___No |
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| For non-firefighter applicants: Are you 16 years old or over? ___Yes ___No |
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| For firefighter applicants: Are you 21 years old or over? ___Yes ___No |
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| List any relatives working for WCSC/WFD ____________________________________________________________________ |
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| Have you ever been convicted or placed on deferred adjudication for any misdemeanor or felony offense in the last seven years? (Criminal convictions are not an automatic bar to employment but will only be considered in relation to specific job requirements) __Yes __No |
| If yes, explain _______________________________________________________________________ |
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| Can you perform the essential functions of the job? ___Yes ___No |
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| Do you require any accommodation to perform the essential functions of the job? ___Yes ___No |
| If yes, explain_________________________________________________________________________ |
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Education and Training
| |
Name and Address of School |
Degree/Major/Course of Study |
| High School |
_________________ |
_________________ |
| College |
_________________ |
_________________ |
| Graduate School |
_________________ |
_________________ |
| Trade school |
_________________ |
_________________ |
|
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| List any other education, training, special skills or certificates/licenses that you possess related to the job __________________________________________________________ |
| ________________________________________________________________________________ |
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| List any machines or equipment on which you are qualified and experienced in operating _____________________________________________________________________ |
| ________________________________________________________________________________ |
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| Typing speed (words per minute) ___________________________________ |
| Dictation speed (words per minute) _______________________________________________ |
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| List any languages that you fluently speak ______________________________ read/write ________________________________________________________________ |
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| Do you have a valid driver's license in this state? ___ Yes ___No |
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| Military experience? ___ Yes ____No |
| If yes, what branch? ___________________________________________________________ |
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| Rank at separation _____________________________________________________________ |
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Employment History
List all experience beginning with the present or most recent job (use back of application if necessary).
| _____________________________________________________________________ |
| Name Of Employer |
Type of Business |
| |
| _____________________________________________________________________ |
| Address |
City |
State |
Zip |
| |
| _____________________________________________________________________ |
| Dates Employed (From - To) |
Title |
| |
| _____________________________________________________________________ |
| Name and Title of Supervisor |
Telephone Number |
| |
| May we contact? |
__ Yes __No |
| Was Employment |
___ Part-time ___Full Time |
| |
| _____________________________________________________________________ |
| Brief Description of Duties |
| |
| _____________________________________________________________________ |
| Reason for Leaving |
Last Salary |
| _____________________________________________________________________ |
| Name Of Employer |
Type of Business |
| |
| _____________________________________________________________________ |
| Address |
City |
State |
Zip |
| |
| _____________________________________________________________________ |
| Dates Employed (From - To) |
Title |
| |
| _____________________________________________________________________ |
| Name and Title of Supervisor |
Telephone Number |
| |
| May we contact? |
__ Yes __No |
| Was Employment |
___ Part-time ___Full Time |
| |
| _____________________________________________________________________ |
| Brief Description of Duties |
| |
| _____________________________________________________________________ |
| Reason for Leaving |
Last Salary |
| _____________________________________________________________________ |
| Name Of Employer |
Type of Business |
| |
| _____________________________________________________________________ |
| Address |
City |
State |
Zip |
| |
| _____________________________________________________________________ |
| Dates Employed (From - To) |
Title |
| |
| _____________________________________________________________________ |
| Name and Title of Supervisor |
Telephone Number |
| |
| May we contact? |
__ Yes __No |
| Was Employment |
___ Part-time ___Full Time |
| |
| _____________________________________________________________________ |
| Brief Description of Duties |
| |
| _____________________________________________________________________ |
| Reason for Leaving |
Last Salary |
|
References
| (List three individuals - not employers or relatives - known to you for at least three years.) |
| Name and Address |
Occupation |
Telephone Number |
| 1. _____________________________________________________________ |
| 2. _____________________________________________________________ |
| 3. _____________________________________________________________ |
| |
| Person to be notified in case of emergency |
| Name |
____________________ |
Telephone |
____________________ |
| Address ________________________________________________________ |
|
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| Please include any other information you think would be helpful to us in considering you for employment, such as additional work experience, articles/books published, activities, honors received, etc. (You may omit all information that would indicate age, sex, race, religion, color, national origin, or handicap) |
| _______________________________________________________________________ |
| _______________________________________________________________________ |
| _______________________________________________________________________ |
|
| AGREEMENT (Please read the following statement carefully) |
| |
| I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. |
| |
| I authorize all persons listed above (and on the accompanying resume, if any) to give The Woodlands Community Service Corporation/The Woodlands Fire Department, Inc. (WCSC/WFD) any and all information concerning my previous employment and education and any pertinent information they may have, personal or otherwise, and release all parties, such persons and WCSC/WFD from liability for any damage that may result from furnishing same to WCSC/WFD. |
| |
| If employed by WCSC/WFD, I agree to conform to the rules and regulations of WCSC/WFD. I further understand that my employment can be terminated, with or without cause or notice, at any time, at the discretion or either WCSC/WFD or myself. I further understand that no manager or representative of WCSC/WFD has any authority to enter into any agreement, oral or written, for employment for any specified period of time or to make any assurance or promise of continued employment. |
| |
| I understand and agree that I may be required to take a drug and alcohol screening test. I hereby give my voluntary consent for a blood and/or urine sample to be collected from me and submitted for testing. I also consent to the release of the test result to WCSC/WFD for its use. I understand that any positive drug or alcohol result may preclude my employment. |
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| Signature _________________________ Date ________________ |
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RELEASE AND AUTHORIZATION
| DISCLOSURE: A CONSUMER REPORT MAY BE PROCURED FOR EMPLOYMENT PURPOSES. |
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| In accordance with the Fair Credit Reporting Act; a consumer report or investigative consumer report including information about your credit, general reputation, character, or personal characteristics may be obtained. Upon written request, you will be provided with information regarding the nature and scope of the report, should it include information about your general reputation, character, or personal characteristics, and a summary of your rights. I understand if my application for employment is granted, further information may be obtained through subsequent investigations so as to update, renew or extend my employment. |
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| RELEASE AND AUTHORIZATION |
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| I voluntarily and knowingly authorize for employment purposes only, any present or past employer or supervisor, university or institution of learning, administrator, law enforcement agency, state agency, federal agency, credit bureau, private business, military branch or the National Personnel Records Center, the Minnesota Bureau of Criminal Apprehension, personal reference, and/or other persons, to give records, credit history, worker's compensation claims (including from the state of MN), general reputation, character, or any other information requested to Pre-Check, Inc. and/or its agents or representatives. I voluntarily and knowingly unconditionally release any named or unnamed informant from any and all liability resulting from the furnishing of this information. A photographic or faxed copy of the authorization shall be as valid as the original. In compliance with the 1990 Americans with Disabilities Act, a worker compensation search may only be requested when a conditional job offer exists. |
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| SIGNATURE _________________________ |
DATE _______________ |
| |
| FULL NAME (Type or Print Legibly) ____________________________________ |
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| STREET ADDRESS ____________________________________ |
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| CITY, STATE, ZIP ____________________________________ |
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| SOCIAL SECURITY NUMBER ____________________________________ |
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| DATE OF BIRTH* ____________________________________ |
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| DRIVER'S LICENSE NUMBER ____________________________________ |
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| STATE OF ISSUE ____________________________________ |
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| *Optional |
| |
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CA and MN APPLICANTS ONLY
You have the right to receive a copy of your Consumer Credit Report (for CA) or Consumer Report (for MN) should one be requested for employment reasons
__ I wish to be furnished with a copy of my consumer report should one be ordered.
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© 2004, Community Associations of The Woodlands, Texas
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