Houston SPCA: Survey - Application for Employment

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Application for Employment

PERSONAL INFORMATION AND DESIRED POSITION

Name:

First Required	Middle Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Phone Number: Required

Question - Not Required - Cell Phone Number

Question - Required - Position Desired

Question - Required - Date Available

Month

Day

Year

Question - Required - Salary Desired

Question - Required - Social Security Number

Question - Required - Type of Employment Desired:
Please make between 1 and 3 selections from the choices below.

	Full-time
	Part-time
	Temporary

Question - Required - What hours are you available to work?

Question - Required - Can you provide proof that you are 18 years of age?

Question - Not Required - If you are under 18, can you submit a work permit?

EDUCATION

Question - Required - High School (please provide name, location, diploma, degree or credits earned if no degree, attendance dates and major)

Question - Not Required - Business, Trade or Technical School (please provide name, location, diploma, degree or credits earned if no degree, attendance dates and major)

Question - Not Required - College (please provide name, location, diploma, degree or credits earned if no degree, attendance dates and major)

Question - Not Required - Graduate School

Question - Not Required - Other

GENERAL

Question - Required - Have you ever applied for a job with the Houston SPCA?

Question - Not Required - If yes, when?

Question - Not Required - List any relatives currently working at the Houston SPCA and their relationship to you

Question - Required - Do you have to ability to perform, with or without an accommodation, the essential functions of the job for which you have applied?

SPECIAL SKILLS OR TRAINING

Question - Required - Please list your experience, starting with the most recent. Highlight your knowledge, skills and abilities that best demonstrate your qualifications for this position. You may list significantly different jobs within the same organization as separate items. Include military service and volunteer activities if they reflect your qualifications for the position for which you are applying. (You may exclude organizational names which would reveal race, color, religion, sex, national origin, age, disability or other protected status.):

EMPLOYMENT HISTORY

Please provide a COMPLETE employment history, even if a resume is submitted with this application. List ALL employers, assignments, or volunteer activities that are relevant to the job for which you are applying, starting with the most recent, including military employment. Explain any gaps in employment in the “Comments” section below.

Question - Required - Present/ Most Recent Employer

Question - Required - Phone Number

Question - Required - Address

Question - Required - Job Title

Question - Required - Immediate Supervisor and Title

Question - Required - Type of Employment Full Time
Part Time
Temporary
Other

Question - Required - Reason for leaving or why you are considering leaving?

Question - Required - May we contact this employer?

Question - Required - Are you eligible for re-hire with this employer?

Question - Required - Date Employed From

Month

Day

Year

Question - Required - Date Employed To

Month

Day

Year

Question - Required - Starting Hourly Rate/ Salary

Question - Required - Final Hourly Rate/Salary

Question - Required - Summarize the nature of the work performed and job responsibilities.

Question - Not Required - Next Previous Employer

Question - Not Required - Phone Number

Question - Not Required - Address

Question - Not Required - Job Title

Question - Not Required - Immediate Supervisor and Title

Question - Not Required - Type of Employment

Question - Not Required - Reason for Leaving?

Question - Not Required - Date Employed From

Month

Day

Year

Question - Not Required - Date Employed To

Month

Day

Year

Question - Not Required - Starting Hourly Rate/Salary

Question - Not Required - Final Hourly Rate/Salary

Question - Not Required - Summarize the nature of the work performed and job responsibilities.

Question - Not Required - Next Previous Employer

Question - Not Required - Phone Number

Question - Not Required - Address

Question - Not Required - Job Title

Question - Not Required - Immediate Supervisor and Title

Question - Not Required - Type of Employment

Question - Not Required - Reason for Leaving

Question - Not Required - Date Employed From

Month

Day

Year

Question - Not Required - Date Employed To

Month

Day

Year

Question - Not Required - Starting Hourly Rate/Salary

Question - Not Required - Final Hourly Rate/Salary

Question - Not Required - Summarize the nature of the work performed and job responsibilities.

Question - Not Required - Next Previous Employer

Question - Not Required - Phone Number

Question - Not Required - Address

Question - Not Required - Job Title

Question - Not Required - Immediate Supervisor and Title

Question - Not Required - Type of Employment

Question - Not Required - Reason for Leaving

Question - Not Required - Date Employed From

Month

Day

Year

Question - Not Required - Date Employed To

Month

Day

Year

Question - Not Required - Starting Hourly Rate/Salary

Question - Not Required - Final Hourly Rate/Salary

Question - Not Required - Summarize the nature of the work performed and job responsibilities.

Question - Not Required - COMMENTS (including explanation of any gaps in employment):

PROFESSIONAL LICENSES

Question - Not Required - List any professional license(s) that are related to the position for which you are applying and list state(s) in which licensed:

Question - Required - Driver's License/ID number and issuing state:

OTHER INFORMATION

Question - Required - If hired, can you prove that you are authorized to work in the United States? Proof of eligibility to work in the United States will be required before an individual can begin employment.

Question - Required - Have you been convicted or received deferred adjudication for or pled guilty or no contest to a felony or misdemeanor? (You should disclose any criminal offense that may appear on your record, even if you are uncertain of the exact date or how a criminal offense was classified, except where prohibited by state law. Please note that answering "yes" to this question does not constitute an automatic bar to employment.)

Question - Not Required - If yes, please provide the following information: Date of Conviction, Charge, Location and Sentence/Outcome:

Question - Required - Have you ever been terminated from or asked to leave any job?

Question - Not Required - If yes, explain:

Question - Required - Have you ever been convicted of or received deferred adjudication for or pled guilty or no contest to cruelty to animals?

CERTIFICATION

I understand that this Employment Application and any attachments are the property of the HOUSTON SOCIETY FOR THE PREVENTION OF CRUELTY TO ANIMALS (“HOUSTON SPCA”). I certify that all answers given and statements made in this Employment Application are true, complete and correct to the best of my knowledge.

I authorize the HOUSTON SPCA to investigate and verify all statements contained in this Employment Application and all data that I provide to the HOUSTON SPCA during the application or hiring process including interviews, if any. I authorize all schools, individuals and employers named in this Employment Application, except my current employer if noted, to provide information requested about me. I release all parties from all liability for any damage that may result from furnishing employment, education, personal or other information about me to the HOUSTON SPCA.

This Employment Application shall be considered active for a period of time not to exceed 45 days. I understand that if I wish to be considered for employment beyond this time period, I should inquire as to whether or not applications are being accepted at this time.

I understand that if I am hired, my relationship with the HOUSTON SPCA will be at-will, meaning that either I or the HOUSTON SPCA may terminate my employment at any time, for any reason or no reason, with or without cause or notice. No promises regarding employment have been made to me, and I understand that nothing in this Employment Application or in the granting of any interview or any offer of employment creates a contract of employment or for providing any benefit unless a specific document to that effect is executed in writing and signed by both me and the President of the HOUSTON SPCA. I agree that no representative of the Company, other than the President, has any authority to enter into any agreement regarding employment for any specified time period or other employment terms or conditions.

I acknowledge that if I need reasonable accommodation in either the application process or employment I will bring my request to the attention of the Human Resources department. The HOUSON SPCA reserves the right to require medical documentation concerning the need for the accommodation.

I understand that to be employed, I must be authorized to work in the United States, and must provide documents to establish my ability to work in the United States. I understand that a tentative offer of employment, if any, will also be contingent upon my successful completion of a background check and reference check.

In the event of employment, I understand that I am required to abide by all policies, rules and regulations of the HOUSTON SPCA. I also understand that the HOUSTON SPCA may revise it’s policies, rules and regulations, in whole or in part, at any time.

BY SIGNING BELOW, I CERITFY THAT ALL STATEMENTS IN THIS APPLICATION ARE TRUE AND UNDERSTAND THAT IF I PROVIDE FALSE OR MISLEADING INFORMATION OR WILLFULLY OMIT INFORMATION IN THIS APPLICATION, ON MY RESUME, DURING MY INTERVIEW, IF ANY, OR DURING MY EMPLOYMENT, IF HIRED, I MAY BE DENIED EMPLOYMENT, OR IF DISCOVERED AFTER HIRE, BE SUBJECT TO DISCIPLINE, UP TO AND INCLUDING IMMEDIATE TERMINATION OF EMPLOYMENT.

IN ADDITION, BY SIGNING BELOW, I ACKNOWLEDGE THAT IF I AM HIRED BY THE HOUSTON SPCA, MY EMPLOYMENT WILL BE AT-WILL, AND THAT I OR THE COMPANY MAY TERMINATE MY EMPLOYMENT AT ANY TIME, FOR ANY REASON OR NO REASON, WITH OR WITHOUT CAUSE OR NOTICE.

Question - Required - I HAVE READ AND AGREE TO THE ABOVE TERMS AND CONDITIONS: