Application

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Application

Angelina County Senior Center is an equal opportunity employer. Application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Application

Applicant Information:

Applicant Information:

Applicant Name:

Address:

City

State

Zip Code

Employment Position:

Employment Position:

How did you hear about this position?

What days are you available for work?

Monday

Tuesday

Wednesday

Thursday

Friday

What hours or shift are you available for work?

Morning

Mid-day

Evening

What date can you start working if hired?

Do you have reliable transportation to and from work?

Yes

Personal Information

Personal Information:

Have you ever applied to work or worked for Angelina County Senior Center before?

Yes

If yes, when?

Do you have any friends, relatives, or acquantances working for Angelina County Senior Center?

Yes

If yes, state name and relationship:

Are you 18 years of age or older?

Yes

Are you a U.S. citizen or approved to work in the United States?

Yes

What document can you provide as proof of citizenship or legal status?

Will you consent to a mandatory controlled substance test?

Yes

Do you have any condition which would require job accommodations?

Yes

If yes, please describe accommodations below.

Have you ever been convicted or a criminal offense (felony or misdemeanor)?

Yes

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case?

Job Skills/Qualifications

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying.

(Note: Angelina County Senior Center complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)

Education and Training

Education and Training

High School

High School Name:

Location (city, state)

Year Graduated

Degree Earned

Yes

College / University

College / University Name:

Location (city, state)

Year Graduated

Degree Earned

Yes

Vocational School / Specialized Training

Vocational / Specialized School Name:

Location (city, state)

Year Graduated

Degree Earned

Yes

Military

Military

Are you a member of the Armed Services

Yes

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Previous Employment

Previous Employment

Prev/emp

Please List your previous employers :

Name
your job title
supervisors name
employer address
telephone
dates employed
reason for leaving

Employer One:

Employer Two:

Employer Three:

References

References:

Ref-info

Please please provide 2 personal and professional reference(s) below:

Reference one name:

Reference one phone:

Reference one email (if applicable)

Reference two name:

Reference two phone:

Reference two email (if applicable)

AT-WILL EMPLOYMENT

By checking you understand and agree to:

AT-WILL EMPLOYMENT: The relationship between you and the Angelina County Senior Center is referred to as "employment at will." This means that your employment can be terminated at any time, for any reason, with or without cause, and with or without notice, by either you or the Angelina County Senior Center. No representative of the Angelina County Senior Center has the authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will status, except through a written statement signed by you and either our Executive Vice President/Chief Operations Officer or the Company President.

Electronic Signature: Please enter your full legal name:

Todays Date:

Resume:

Upload File

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2801 Valley Ave, Lufkin, TX 75901, United States of America

211 Texas: 211

Health & Human Services Ombudsman: 877.323.6466

Adult Protective Services: 800.252.5400

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