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Employment Application

APPLICANT INFORMATION

Today's Date*

Social Security Number*

Applicant's Name*

Marital Status*

Multi-line address

Country/Region*

Address*

Address - line 2

City*

Zip / Postal code*

18 or Older? If yes, list date of birth.*

Ever worked or attended school under any other name?*

Phone Home/Cell *

Email*

Are you a US Citizen? Or an alien authorized to work in the USA?*

If you have EAD, please provide the Alien Registration Number.

Ever been convicted of a crime? If yes, give dates & details.

A yes answer will not automatically disqualify you from this job. We consider the nature and the date of the offense and the job you are applying for, job related purposes only, and only to the extent permitted by applicable law.

POSITION DESIRED

Title of position you are applying for*

Date you can start work*

Hourly rate desired?*

Full Time/Part Time Work?*

If part time how many hours?*

Days of Week Available?*

Hours Available?*

Available to work weekends?*

Yes

No

Available to work holidays?*

Yes

No

Available to work nights?*

Yes

No

Available to work overtime?*

Yes

No

Are you related to a current of former employee of TLA? If yes, please provide employees name.*

Have you ever worked for Thomas & Lewin? Is yes, state when.*

IN CASE OF EMERGENCY

Emergency Contact Name*

Relationship*

Phone*

Email*

EDUCATION

High School/Course of Study*

Graduated?*

Yes

No

Technical School/Course of Study*

Graduated?*

Yes

No

College University/Course of Study*

Graduated?*

Yes

No

Other Education or Training*

Other Special Skills*

WORK EXPERIENCE

Please list all previous employment, beginning with the most recent. If you need additional room, you may email us additional information.

Current or Most Recent Employer*

Company Address*

Company Phone*

Supervisor Name*

Okay to contact Supervisor?*

Yes

No

Reason for Leaving*

Position Held*

From/To Dates of Employment*

Beginning Pay*

Ending Pay*

Describe your duties*

Previous Employer*

Company Address*

Company Phone*

Supervisor Name*

Okay to contact Supervisor?*

Yes

No

Reason for Leaving*

Position Held*

From/To Dates of Employment*

Beginning Pay*

Ending Pay*

Describe your duties*

Previous Employer*

Company Address*

Company Phone*

Supervisor Name*

Okay to contact Supervisor?*

Yes

No

Reason for Leaving*

Position Held*

From/To Dates of Employment*

Beginning Pay*

Ending Pay*

Describe your duties*

AUTHORIZATION & ACKNOWLEDGEMENTS

I hereby authorize any investigator or duly accredited representatative of Thomas & Lewin Associates, Inc. bearing this release to obtain any information from schools, residential management agents, employers, criminal justice agencies, or individuals, relating to my activities. This information may include, but is not limited to, academic, residential, achievement, performance, attendance, personal history, disciplinary arrest, and conviction records. I hereby direct you to release

such information upon request of the bearer. I understand that the information is for official use by Thomas & Lewin Associates, Inc. and may be disclosed to such 3rd parties as necessary in the fulfillment of official responsibilities. I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind or

nature which may at any time result to me on account of compliance, or any attempts to comply, with this authorization.

Signature

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GET IN TOUCH

2025 Avenue G

Rosenberg, TX 77471

(281) 679-1309

office@texashcs.com

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© 2024 by Thomas & Lewin Associates, Inc. Designed by Designed by Kelly Thomas, LLC

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