Prairie​ ​ Harbor​ ​ Employment​ ​ Application

Prairie​ ​ Harbor​ ​ Employment​ ​ Application

PERSONAL ​ INFORMATION
NAME
ADDRESS
CONTACT DETAILS
EMAIL ADDRESS
Position​ ​ Desired​ ​ (Work​ ​ Preference):
Check​ ​ One:

Are​ ​ you​ ​ available​ ​ to​ ​ work:
Full-Time?
Part-Time?


Evenings?


Weekends?


Overtime?


What days and hours are you available to work?
How did you hear about Prairie Harbor?
Highest Grade Completed
Did​ ​ you​ ​ graduate​ ​ High​ ​ School​ ​ and​ ​ have​ ​ a ​ ​ transcript​ ​ or​ ​ diploma?






Other Special Training and/or Certifications:
Can​ ​ you​ ​ read​ ​ and​ ​ write​ ​ English?


Do​ ​ you​ ​ have​ ​ any​ ​ friends,​ ​ relatives,​ ​ or​ ​ acquaintances​ ​ working​ ​ for​ ​ Prairie​ ​ Harbor?


If yes, state name & relationship:
Have​ ​ you​ ​ ever​ ​ been​ ​ convicted​ ​ of​ ​ a ​ ​ criminal​ ​ offense​ ​ (felony​ ​ or​ ​ misdemeanor)?​ ​


If​ ​ yes,​ ​ please​ ​ describe​ ​ the​ ​ crime(s),​ ​ state​ ​ nature​ ​ of​ ​ the​ ​ crime(s),​ ​ when​ ​ and​ ​ where​ ​ convictedand​ ​ disposition​ ​ of​ ​ the case
Are​ ​ you​ ​ aware​ ​ of​ ​ any​ ​ reason(s)​ ​ which​ ​ would​ ​ prevent​ ​ you​ ​ from​ ​ consistently​ ​ performing​ ​ the specific​ ​ duties​ ​ necessary​ ​ to​ ​ do​ ​ the​ job for​ ​which​ ​ you​ ​ have​ ​ applied?​ ​ ​ ​ ​


If yes, state name & relationship:
Are​ ​ you​ ​ using​ ​ any​ ​ medication​ ​ which​ ​ would​ ​ affect​ ​ your​ ​ ability​ ​ to​ ​ perform​ ​ the​ ​ specific​ ​ duties necessary​ ​ to​ ​ the​ ​ job​ ​ for​ ​ which​ ​ you​ have​ ​ applied?​


Do​ ​ you​ ​ have​ ​ reliable​ ​ transportation?​ ​ ​ ​ ​ ​


All​ ​ Prairie​ ​ Harbor​ ​ employees​ ​ are​ ​ required​ ​ to​ ​ be​ ​ drug-free​ ​ as​ ​ a ​ ​ condition​ ​ of​ ​ employment,​ ​ and must​ ​ submit​ ​ to​ ​ an​ ​ initial​ ​ and​ ​ subsequent​ ​ random​ ​ drug​ ​ testing.​ ​ Would​ ​ you​ ​ be​ ​ willing​ ​ to​ ​ submit a​ ​ drug​ ​ test​ ​ for​ ​ employment​ ​ reasons?​​


How​ ​ much​ ​ time​ ​ have​ ​ you​ ​ lost​ ​ from​ ​ work​ ​ during​ ​ the​ ​ past​ ​ twelve​ ​ months?​
For​ ​ what​ ​ reason(s)?
(Give​ ​ complete​ ​ record​ ​ of​ ​ business​ ​ or​ ​ employment​ ​ for​ ​ past​ ​ seven​ ​ years.)








































What​ ​ was​ ​ the​ ​ reason​ ​ for​ ​ leaving​ ​ your​ ​ last​ ​ employment?
May​ ​ we​ ​ contact​ ​ this​ ​ employer?​ ​


If​ ​ presently​ ​ employed,​ ​ how​ ​ much​ ​ notice​ ​ to​ ​ present​ ​ employer​ ​ is​ ​ necessary?​
Have​ ​ you​ ​ ever​ ​ worked​ ​ with​ ​ children?​ ​ ​​ ​


If​ ​ present In​ ​ what​ ​ capacity?
In​ ​ your​ ​ own​ ​ words,​ ​ please​ ​ write​ ​ a ​ ​ brief​ ​ explanation​ ​ of​ ​ why​ ​ you​ ​ want​ ​ to​ ​ be​ ​ employed​ ​ by​ ​ Prairie Harbor:
(List​ ​ below​ ​ three​ ​ persons​ ​ who​ ​ have​ ​ knowledge​ ​ of​ ​ your​ ​ work​ ​ performance​ ​ within​ ​ the​ ​ last​ ​ four years.​ ​ Please​ ​ include​ ​ professional ​ ​ references ​ ​ only ​ .)








































I certify that the foregoing information is true and correct to the best of my knowledge, and I understand that any misrepresentation or willful omission of facts shall be cause for rejection of this application or termination of employment


I hereby authorize Prairie Harbor to conduct a work history reference check to determine my acceptability for employment. I further agree to hold Prairie Harbor and any former employer I have provided, harmless concerning any information or the use of any information furnished by the reference.


Pursuant to Texas Education Code, Section 21.917, I hereby authorize Prairie Harbor to obtain a Driver’s License check and any criminal history record information pertaining to me from any law enforcement agency.


I further agree to observe all rules, regulations, and policies of Prairie Harbor.