APPLICANT INSTRUCTIONS
Thank You for your interest in working at our facility. Our people make us successful and the employment process is an important aspect of building our team. We appreciate your application and are glad you have shown an interest in joining our team. This sheet is for your information. Please tear it off and keep it for reference.
Please complete the attached application and authorization for the release of information Please print all information so that it may be easily read. Be careful that each section is completely filled out and that you sign and date the application and the Release of Employment Records. Use the abbreviation “N/A” if a particular provision or section of the form is not applicable to you. Incomplete applications will not be considered.
Please note the following:
THIS FACILITY DOES NOT SUBSCRIBE TO THE WORKER’S COMPENSATION PROGRAM. WE HANDLE EMPLOYEE INJURIES THAT OCCUR ON THE JOB THROUGH OUR OWN MANAGED CARE APPROACH TO HEALTH BENEFITS. YOU WILL HAVE CERTAIN RESPONSIBILITIES IN THAT REGARD IF YOU ARE EMPLOYED AND WISH TO HAVE SUCH BENEFITS AVAILABLE TO YOU.
After you have completed your application, it will not be necessary for you to contact this office regarding job openings. We will keep your application in our active files for three (3) months. Should an opening occur, your application will be reviewed along with others. If you are among the most qualified applicants for a position, an interview will be arranged. Please notify us in writing if your address or phone number should change.
After you have completed your application, it will not be necessary for you to contact this office regarding job openings. We will keep your application in our active files for three (3) months. Should an opening occur, your application will be reviewed along with others. If you are among the most qualified applicants for a position, an interview will be arranged. Please notify us in writing if your address or phone number should change.
Employment decisions are made solely on the basis of qualifications to perform the work for which you are applying. Qualifications include education, training, work experience, and other factors which are relevant in determining job performance. Credentials and experience will be verified through schools, former employers, and licensing certification agencies, if applicable. As an Equal Opportunity Employer, decisions to hire and promote are made without regard to race, color, creed, national origin, sex, pregnancy, physical or mental disability or age (as defined by law).
We appreciate your cooperation. Thanks!
PERSONAL INFORMATION
Notify in case of emergency:
If yes, please list what State:
If yes, please list relative(s) name:
EMPLOYMENT DESIRED AND AVAILABLITY
List any Special Licenses you possess:
GENERAL INFORMATION
If you do not want us to ask your present employer for references, please explain why not.
If yes, please explain. (A conviction will not necessarily bar you from employment).
EDUCATION
High School
College
Trade, Business, Or Correspondence School
SKILLS
Please list any special skills, abilities or job-related experience, including the use of any special equipment or machines. Please list any special computer knowledge, skills, or other certifications:
PERSONAL REFERENCES
(Must be individuals who have direct knowledge of your work history. Do not list relatives.)
EMPLOYMENT HISTORY
List ALL present and past employment in the section below, beginning with your most recent employer and working your way back from the last five years. Failure to list all employers may delay screening process.
PLEASE COMPLETE THIS SECTION- EVEN IF YOU ARE ATTACHING A RESUME
PERIODS OF UNEMPLOYMENT
List ALL periods of unemployment in the section below, beginning with your most recent period and working your way back for the last five years.
This section should account for all gaps in Employment History.
Employers in Texas have a legal duty in regard to each employee's safety. You, your fellow workers’ and our residents safety is of utmost importance to West Rest Haven. It is neither beneficial for you nor us to place you in a job where you have a higher risk of injury because of a physical or mental condition. As an Equal Opportunity Employer, we consider applicants for employment regardless of their disabilities; however, in addition to our own requirement, the Americans with Disabilities Act also requires us to make certain that each employee is capable of performing the essential functions of the job. Therefore, you must be honest with us in regard to your personal evaluation as to your abilities to perform the essential functions as described in the job description.
PLEASE READ AND SIGN THE FOLLOWING
APPLICANT PLEASE READ CAREFULLY BEFORE SIGNING.
I certify that all the information given on this application is true, correct, and complete to the best of my knowledge. I also certify that I have accounted for 5 years of work experience, and that I have not knowingly withheld any fact of circumstance which would, if disclosed, affect my application unfavorably.
West Rest Haven is hereby authorized to make any investigation of my past employment (current employment, if indicated above that this would not pose any difficulty), educational, credit or criminal history through any investigative agencies or bureaus of its choice. | release all relevant parties from all liability of any damages resulting from furnishing such information.
I understand that an offer of employment and continued employment is contingent upon my furnishing satisfactory proof of my authorization to work in the United States.
If employed by West Rest Haven, I agree to abide by its rules and regulations. I understand that discovery of misrepresentation or omission of facts herein will make me ineligible for employment or to will be cause for immediate dismissal. I agree to furnish additional information as may be required complete my employment file. I understand that operating conditions may require me to work shifts other than the one for which I am applying and I agree to such scheduling change as directed by my supervisor
I also understand that my employment is subject to the completion of the Medical Examination and Mobility Evaluation, which may include a drug and alcohol screening and that my continued employment may be conditioned upon maintaining a favorable health evaluation and/or drug/alcohol can be supplied to the authorized agent of this facility, upon their request.
I understand that this is an application for employment and that no employment contract, either expressed or implied, is being offered. I also understand that if employed, such employment is for an indefinite period and can be terminated at will be either party, with or without notice, at any time, for any or no reason, and is subject to change in wages, conditions, benefits, and operating policies.
EMPLOYMENT APPLICANT’S AUTHORIZATION
FOR RELEASE OF EMPLOYMENT RECORDS
I, , hereby authorize West Rest Haven to investigate all facts contained in my application for employment with said facility, and authorize the release of any and all information by my present (if indicated on application that this would not pose any difficulty) and past employers, wherever located, which may be required for a reference check. I further authorize all of my previous employers and current employer to give any and all information concerning my employment and any other pertinent information which said employers may have, personal or otherwise, and I release all parties from all liabilities for any damages which may result from the furnishing of said information.
A copy of this release shall be valid as the original.
DPS Computerized Criminal History (CCH) Verification
(AGENCY COPY)
I, , acknowledge that a Computerized Criminal History (CCH) check may be performed by accessing the Texas Department of Public Safety Secure Website and may be based on name and DOB identifiers. (This is not a consent form, but serves as information for the applicant.) Authority for this agency to access an individual’s criminal history data may be found in Texas Government Code 411, Subchapter F.
Name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history record information (CHRI), therefore the organization conducting criminal history check is not allowed to discuss with me any CHRI obtained using the name and DOB method. The agency may request that I also have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search.
In order to complete the fingerprint process I must make an appointment with the F ingerprint Applicant Services of Texas (FAST) as instructed online at www.txdps.state.tx.us /Crime Records/Review of Personal Criminal History or by calling the DPS Program Vendor at 1-888-467-2080, submit a full and complete set of fingerprints, request a copy be sent to the agency listed below, and pay a fee of $25.00 to the fingerprinting services company.
Once this process is completed the information on my fingerprint criminal history record may be discussed with me.
(This copy must remain on file by this agency. Required for future DPS Audits)
