Employment Application

PERSONAL

Name(Required)

First Middle Last

Other Names

Social Security Number(Required)

Home Phone(Required)

Other Phone

Address(Required)

Street Address Address Line 2 City State ZIP Code

U.S. Citizen?(Required)

Yes

If no, type of work authorization document:(Required)

Expiration Date(Required)

JOB DATA

Position or type of work desired 1(Required)

Position or type of work desired 2

Seeking(Required)

Full Time

Part Time

Temporary

Shift willing to work(Required)

Day

Night

Evening

Rotating

Available to work weekends?(Required)

Yes

Salary Required

Are you presently employed?(Required)

Yes

May we contact your present employer?(Required)

Yes

Previously employed by TMC Laundry?(Required)

Yes

Dates previously employed by TMC Laundry(Required)

Date available for work(Required)

U.S. MILITARY

Branch of U.S. Service

Date Entered

Date of Discharge

Rank at Discharge

Nature of duties and special training received

EDUCATION AND TRAINING

Please indicate any educational, vocational, on-the-job, or any other training you have received which will aid us in placing you in the position that best meets your qualifications and / or determining your qualifications for a position for which you deserve to be considered.

Middle School (Name of school)

Location of school

Date Attended From (mo/yr)

Date Attended To (mo/yr)

Number of grades completed

High School (Name of school)

Location of school

Date Attended From (mo/yr)

Date Attended To (mo/yr)

Degree/Diploma

Yes

Subject Emphasized

College (Name of college)

Date Attended From (mo/yr)

Date Attended To (mo/yr)

Degree/Diploma

Yes

Major / Minor

Graduate School(Name of school)

Date Attended From (mo/yr)

Date Attended To (mo/yr)

Degree/Diploma

Yes

Degree

Other schools or special training, including other skills

English

Read

Write

Speak

Other language

Other Language

Read

Write

Speak

Typing Speed WPM

Office machines or other special equipment used

Are you register, certified, or licensed for any profession, skill, or trade? Please specify (include driver's license if applying for a driving job).

License No.

State

Year Obtained

Expiration Date

GENERAL

Have you ever been convicted of or been on deferred adjudication for, or are you now either awaiting trial for or on deferred adjudication for, a felony or misdemeanor?

Yes

If yes, describe in full, including dates and locations. Conviction will not necessarily bar employment.

WORK EXPERIENCE PRESENT/LAST

Name of Employer

Type of Business

Full Address

Your name as it appeared in employer's records

Started (mo/year)

Left (mo/year)

Starting Pay

Final Pay

Name of Supervisor

Title of Supervisor

Telephone

Job title and description of duties and responsibilities

Reason for leaving

Name of Employer

Type of Business

Full Address

Your name as it appeared in employer's records

Started (mo/year)

Left (mo/year)

Starting Pay

Final Pay

Name of Supervisor

Title of Supervisor

Telephone

Job title and description of duties and responsibilities

Reason for leaving

Name of Employer

Type of Business

Full Address

Your name as it appeared in employer's records

Started (mo/year)

Left (mo/year)

Starting Pay

Final Pay

Name of Supervisor

Title of Supervisor

Telephone

Job title and description of duties and responsibilities

Reason for leaving

REFERRALS

How were you referred to TMC Laundry?

Employee referral

Newspaper Ad

Other - explain

Name

Name of the referring employee.

Date of Ad

Date of Ad in case of referral from newspaper ad.

explain

Please explain.

Do you have relatives employed at TMC Laundry? If so, who?

Relationship

RELEASE FOR INFORMATION

Public law 91-508 requires that we advise you that a routine inquiry may be made which will provide information concerning your character, reputation , personal characteristics, and mode of living. You may obtain a copy of this information upon written request.

I hereby certify that the information I supplied in this application is true, complete, and correct to the best of my knowledge, and I understand that any information I withheld or falsely provided in connection with the foregoing application shall be cause for rejection of this application or termination of employment. I hereby authorize Texas Medical Center Hospital Laundry, without liability, to contact prior employers (present employers if authorized), schools or references I have given and authorize said employers, schools or referenced to make full response to the inquiries by Texas Medical Center Hospital Laundry in connection with this application for Employment , including police records. I agree to observe and abide by all rules, regulations, policies and procedures of Texas Medical Center Hospital Laundry. I understand and agree that if employed, my employment with the institution will be of "at will" relationship, and my employment may be terminated by me or the institution at any time without notice, with or without cause. I also understand and agree that the "at will" nature of this relationship cannot be modified except by specific written agreement executed by the undersigned and the President of the institution. I further agree that any and all conditions of my employment, including any compensation and benefits, can be changed or terminated with or without cause or notice at any time by the institution, and that any employee handbook, policy manual, or other communications to employees are not to be construed as creating any form of contract of employment agreement between the undersigned and the institution.

I understand, and agree, that as a condition of employment I may be required to pass scheduled physical examinations as they relate to my ability to discharge my duties. I HAVE READ, UNDERSTAND, AND AGREE TO THE FOREGOING PARAGRAPHS.

Signature(Required)

Date