Application for Employment - Children’s Home of Lubbock

APPLICANT INFORMATION
Full Legal Name*
First Middle Last
Other name you have been known by:
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Home Phone*
Cell Phone*
The following information is required for the Texas DFPS Criminal Background Investigation:
Date of Birth*
Month
Day
Year
Social Security Number*
Do you have a valid driver's license?*
Driver's License Number:*
Issuing State:*
Expiration Date:*
Proof of Auto Insurance?*
Ethnicity:*
Race:*
Other cities of Residence in Texas:
List any Out-of-State Residences in the U.S. in the Last 5 years:

EMPLOYMENT HISTORY - PLEASE READ
IMPORTANT: ALL APPLICANTS MUST SUBMIT EMPLOYMENT HISTORY FOR THE LAST 5 YEARS OF EMPLOYMENT. PLEASE COMPLETE THIS SECTION EVEN IF YOU ARE SUBMITTING A RESUME.
Employer*
Starting Date*
Month
Day
Year
Ending Date*
Month
Day
Year
Location*
City State
Supervisor Name*
Supervisor Phone Number*
Starting Pay*
Ending Pay*
State your job title and the responsibilities of your position:*
Employer (2)
Starting Date
Month
Day
Year
Ending Date
Month
Day
Year
Location
City State
Supervisor Name
Supervisor Phone Number
Starting Pay
Ending Pay
State your job title and the responsibilities of your position:
Employer (3)
Starting Date
Month
Day
Year
Ending Date
Month
Day
Year
Location
City State
Supervisor Name
Supervisor Phone Number
Starting Pay
Ending Pay
State your job title and the responsibilities of your position:
Employer (4)
Starting Date
Month
Day
Year
Ending Date
Month
Day
Year
Location
City State
Supervisor Name
Supervisor Phone Number
Starting Pay
Ending Pay
State your job title and the responsibilities of your position:

REFERENCES
Please list any business or education-related references you would like us to consider.
Name*
First Last
Reference 1
Email*
Enter Email Confirm Email

Reference 1
Business Phone
Reference 1
Home Phone*
Reference 1
Business/Education Relationship to You*
Reference 1
Years Acquainted*
Reference 1
Name*
First Last
Reference 2
Business Phone*
Reference 2
Email*
Enter Email Confirm Email

Reference 2
Home Phone
Reference 2
Business/Education Relationship to You*
Reference 2
Years Acquainted*
Reference 2
Name*
First Last
Reference 3
Business Phone*
Reference 3
Email*
Enter Email Confirm Email

Reference 3
Home Phone*
Reference 3
Business/Education Relationship to You*
Reference 3
Years Acquainted*
Reference 3

OTHER INFORMATION
If you have a resume, attach it here. A resume is not required but is appreciated. PDF ONLY.
Resume
Accepted file types: pdf, Max. file size: 150 MB.
PDF ONLY
References
Accepted file types: pdf, Max. file size: 150 MB.
PDF ONLY
CERTIFICATION
(Please read carefully before signing)
*
I agree. I certify that all answers or statements I have made on this application or on my resume or other supplementary materials are true and correct without omissions. I acknowledge that any false statement or misrepresentation on my application or supplementary materials will be cause for refusal to hire or for immediate dismissal from employment at any time during the period of employment. I hereby authorize The Children's Home to conduct any investigation of my background deemed necessary.
*
I agree. As a condition of employment, I further authorize the companies and schools previously listed, unless otherwise indicated, to give all information concerning my previous employment and any pertinent information they may have, and release all parties from liability for any damage that may result from furnishing such information to the Home. Offers of employment are conditional on the receipt of satisfactory responses to reference requests.
*
I agree. I understand that my employment is pending satisfactory results of a post-offer pre-employment health screen, drug test, background investigation, driving history, and satisfactory proof of identity and legal authority to work in the United States.
*
I agree. In consideration of my employment, I agree to conform to the rules and standards of The Children's Home as amended from time to time and agree that my employment and compensation can be terminated “at will”, with or without cause, and with or without notice at any time, either at my option or at the option of the Home. I agree that this shall constitute a final and fully binding integrated agreement with respect to the at-will nature of my employment relationship and that there are no oral or collateral agreements regarding this issue.
Check Below*
I agree that checking the "I agree" box and entering my name and date, constitutes an electronic signature of this Application under the Electronic Signature in Global and National Commerce Act.
e-Signature*
Please input your full legal name as your e-signature.
Today's Date*
Month
Day
Year
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Online Application for Employment

Step 1 of 7

Position you are applying for?

APPLICANT INFORMATION

GENERAL INFORMATION

EDUCATION INFORMATION

MILITARY SERVICE RECORD

EMPLOYMENT HISTORY - PLEASE READ

REFERENCES

OTHER INFORMATION

CERTIFICATION