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Employment / Job Application

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Employment / Job Application

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Employment / Job Application

PERSONAL INFORMATION

FULL NAME:

DATE:

STREET

CITY

STATE/PROVINCE

ZIP/POSTCODE

E-MAIL:

PHONE:

SOCIAL SECURITY NUMBER (SSN):

DATE AVAILABLE:

DESIRED PAY: $

PREFER

HOURSALARY

EMPLOYMENT DESIRED:

FULL-TIMEPART-TIMESEASONAL

EMPLOYMENT ELIGIBILITY

ARE YOU A U.S. CITIZEN?

YESNO

*IF NO, ARE YOU ALLOWED TO WORK IN THE U.S.?

YESNO

HAVE YOU EVER WORKED FOR THIS EMPLOYER?

YESNO

*IF YES, WRITE THE START AND END DATES:

HAVE YOU EVER BEEN CONVICTED OF A FELONY?

YES*NO

*IF YES, PLEASE EXPLAIN:

EDUCATION

HIGH SCHOOL:

FROM:

CITY / STATE:

TO:

GRADUATE?

YESNO

DIPLOMA:

COLLEGE:

FROM:

CITY / STATE:

TO:

GRADUATE?

YESNO

DEGREE:

OTHER:

FROM:

CITY / STATE:

TO:

DEGREE:

OTHER:

CITY / STATE:

FROM:

TO:

EMPLOYMENT HISTORY

EMPLOYER #1:

E-MAIL:

PHONE:

STREET

CITY

STATE/PROVINCE

ZIP/POSTCODE

STARTING PAY: $

PREFER

HOURSALARY

ENDING PAY: $

PREFER

HOURSALARY

JOB TITLE:

RESPONSIBILITIES:

STARTING DATE:

ENDING DATE:

REASON FOR LEAVING:

EMPLOYER #2:

E-MAIL:

PHONE:

STREET

CITY

STATE/PROVINCE

ZIP/POSTCODE

STARTING PAY: $

PREFER

HOURSALARY

ENDING PAY: $

PREFER

HOURSALARY

JOB TITLE:

RESPONSIBILITIES:

STARTING DATE:

ENDING DATE:

REASON FOR LEAVING:

EMPLOYER #3:

E-MAIL:

PHONE:

STREET

CITY

STATE/PROVINCE

ZIP/POSTCODE

STARTING PAY: $

PREFER

HOURSALARY

ENDING PAY: $

PREFER

HOURSALARY

JOB TITLE:

STARTING DATE:

RESPONSIBILITIES:

ENDING DATE:

REASON FOR LEAVING:

REFERENCES

REFERENCE #1:

RELATIONSHIP:

E-MAIL:

RELATIONSHIP:

TITLE:

PHONE:

REFERENCE #2:

RELATIONSHIP:

COMPANY:

E-MAIL:

TITLE:

PHONE:

REFERENCE #3:

COMPANY

E-MAIL:

RELATIONSHIP:

TITLE:

PHONE:

MILITARY SERVICE

ARE YOU A VETERAN?

YESNO

BRANCH:

STARTING DATE:

RANK AT DISCHARGE:

ENDING DATE:

TYPE OF DISCHARGE:

IF NOT HONORABLE, PLEASE EXPLAIN:

BACKGROUND CHECK CONSENT

IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK?

YESNO

DISCLAIMER

Applicant understands that this is an Equal Opportunity Employer and committed to excellence through

diversity. In order to ensure this application is acceptable, please print or type with the application being

fully completed in order for it to be considered.

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this

application leads to my eventual employment, I understand that any false or misleading information in my

application or interview may result in my employment being terminated.

SIGNATURE:

DATE:

PRINT NAME

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Contact Us

  4228 S. Lancaster Rd Dallas, TX 75216

  1-469-802-9422

  preparedplacefh@gmail.com

  600 North Prairieville St. Athens, TX 75751

1-903-904-4600

preparedplacefh@gmail.com

4228 S. Lancaster Rd
Dallas, TX 75216

600 North Prairieville St.
Athens, TX 75751

Member since 2017
A+ rating

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Now serving Henderson County and surrounding areas of East Texas

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Visit www.prepaidfunerals.texas.gov for information relating to the purchase of pre-need funeral contracts including descriptions of the trust and insurance funding options available under state law.

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