Employment Application 

Unending Possabilities (UP) is an Equal Opportunity Institution and EEO/Affirmative Action Employer 
committed to excellence through diversity. Employment offers are made on the basis of qualifications and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation. 
PLEASE TYPE OR PRINT. Save and complete the entire application. You may attach a resume, but you must still complete all questions; or your application will be deemed incomplete and may not be considered. Please fill out each box (do not indicate “See Resume.”) If you do not save prior to completing the application, your responses may not be saved. Online Applicants: There is an addendum to the application once an applicant reaches the interview stage that includes personal information for background check purposes.
 
Last Name*
 
First Name*
Middle Initial
 
Date
 
Street Address
City
Previous Address
Phone
Desired_Position
Referred By
Are you a citizen of the United States?
Have you ever worked for this company?
Days you ARE NOT available to work?
Do you have any physical limitations we should be aware of?
If YES, please describe your physical limitations?
List any other names you have used in the past (Maiden name, alias, etc.)
High School
High School Address
High School Starting From (Year)?
High School To (Year)?
Did you graduate?
College
College Address
College From (Year)
College To (Year)
Did you graduate?
Other
Other Address
Other From (Year)
Other To (Year)
Did you graduate?
Teacher Certificates
Courses / Seminars
Company 1
Company 1 Phone
Company 1 Address
Company 1 Job Title
Company 1 Starting Salary
Company 1 Ending Salary
Company 1 Responsibilities
Company 1 From (Year)
Company 1 To (Year)
Company 1 Reason For Leaving
May we contact your previous supervisor for a reference?
Company 1 Supervisor Name
Company 2
Company 2 Phone
Company 2 Address
Company 2 Job Title
Company 2 Starting Salary
Company 2 Ending Salary
Company 2 Responsibilities
Company 2 Start (Year)
Company 2 To (Year)
Company 2 Reason For Leaving
May we contact your previous supervisor for a reference?
Company 2 Supervisor Name
Company 3
Company 3 Phone
Company 3 Address
Company 3 Job Title
Company 3 Start Salary
Company 3 Ending Salary
Company 3 Responsibilities
Company 3 Start (Year)
Company 3 To (Year)
Company 3 Reason for Leaving
May we contact your previous supervisor for a reference?
Company 3 Supervisor Name
Relevant Experience
What is your interest in this group of people?
Skills and Talents
Reference Name 1
Reference Relationship 1
Reference Company 1
Reference Phone 1
Reference Address 1
Reference Name 2
Reference Relationship 2
Reference Company 2
Reference Phone 2
Reference Address 2
Reference Name 3
Reference Relationship 3
Reference Company 3
Reference Phone 3
Referece Address 3
Reference Name 4
Reference Relationship 4
Reference Company 4
Reference Phone 4
have you been convicted under the Texas Controlled Substances Act?
If so, when?
Criminal Offense (non-minor)
If so, when?
Please Explain

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION. I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Unending Possabilities to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of Unending Possabilities serve at-will, and the employment relationship may be terminated at any time by either party, for any or no reason, other than a reason prohibited by law.

Signature*
Signature Date

I understand Unending Possabilities (UP) in Van is a drug free workplace and I hereby voluntarily consent for a urine or hair sample to be collected from me and submitted for a drug screening test. Further, I consent to the release of the test results to Human Resources Department for their confidential review and use in determining my suitability for employment with UP. I understand that any positive test results may preclude my employment.

Signature
Signature Date

B. Background Screening, Consumer Report & Investigative Consumer Report Request, Authorization, Consent and Release

I understand that in conjunction with my application for employment, Unending Possabilities (UP) will use the services of an outside agency to procure consumer and/or investigative consumer reports in order to research and verify the information that I have provided with my application for employment. I understand that specifically, the following information will be used to obtain information concerning my criminal history as well as information from the department of motor vehicles in order to determine my eligibility for employment. This information will not be used to violate the spirit of law as it refers to Title VII of the Civil Rights Act of 1964, especially as it relates to age, sex, and ethnicity, in the hiring decision.

I request, authorize and consent to the procurement of consumer reports by UP as part of the employment application investigation. I understand that these reports may include the following types of information: motor vehicle accidents, drugs/alcohol use, criminal history, or any other information about me which may reflect upon my potential for employment gathered from any individual organization, entity, agency or other source which may have knowledge concerning such information. Such reports may contain public record information concerning my motor vehicle driving record and criminal records, etc. from federal, state and other agencies.

I also request, authorize and consent to the procurement of an investigative consumer report by Unending Possabilities as part of the employment application investigation. I understand that the investigative consumer report may contain information about my background, character, personal characteristics, and general reputation and may contain information from public record sources or personal interviews with neighbors, friends or associates.

Attached to this form is a copy of the summary of the rights of the consumer pursuant to the Fair Credit Reporting Act (“FCRA”). I know that, upon written request, I will be entitled to a complete disclosure concerning the nature and scope of this investigation, copies of the consumer reports, and the name, address, and telephone number of the consumer reporting agencies that issued reports to the Community. In accordance with the FCRA, 15 U.S.C. §§ 1681-1681u, the Community will notify me prior to and after taking adverse action against me such as denying employment, because of information obtained from a consumer report and/or investigative consumer report.

I hereby fully release and discharge Unending Possabilities, its directors, officers, employees, agents and attorneys thereof, and each of them, and any individual, organization, entity, agency or other source providing information to Unending Possabilities for all claims and damages arising out of or relating to any investigation of my background for employment purposes. This release is valid for all federal, state, county and local agencies, authorities, previous employers, military services and educational institutions.

By signing below, I certify that I have read and fully understand this authorization and release, that prior to signing I was given an opportunity to ask questions and to have those questions answered to my satisfaction, and that I executed this authorization and release voluntarily and with the knowledge that the information being authorized and released could affect my being hired, my employment, or my eligibility for promotion.

Signature*
Signature Date
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