AN EQUAL OPPORTUNITY EMPLOYER
AT-WILL AGENCY
EMPLOYMENT APPLICATION
HIGH SKY CHILDREN'S RANCH
8701 WEST COUNTY ROAD 60
MIDLAND, TEXAS 79707
432-694-7728
Revised 10/16/06
NAME_______________________________________________________________________
_______________________________________________________
OTHER NAMES GONE BY OR KNOWN AS
STREET ADDRESS _____________________________________________________________
CITY, STATE, ZIP ______________________________________________________________
PHONE #______________________________________________________________________
EMERGENCY CONTACT ________________________________________________________
POSITION DESIRED _______________________ DATE AVAILABLE TO START___________
CURRENTLY EMPLOYED: NO_____YES_______
MAY WE CONTACT PRESENT EMPLOYER FOR INFORMATION ? YES_______NO_______
EVER BEEN EMPLOYED BY HIGH SKY BEFORE? _________________________________
EDUCATION
DO YOU HAVE A HIGH SCHOOL DIPLOMA? ________ GED? _______ ( Please check)
COLLEGE ATTENDED__________________________________________________________
HOURS ____________ DEGREE __________________________________________________
SPECIALIZED TRAINING
______________________________________________________________________________
DRIVERS LICENSE # __________________ STATE ____________ EXPIRATION _________
LIST ALL TRAFFIC OFFENSES IN THE PAST THREE YEARS
ANY PERSON INTERESTED IN EMPLOYMENT AT HIGH SKY CHILDREN'S RANCH
ANY PERSON INTERESTED IN EMPLOYMENT AT HIGH SKY CHILDREN'S RANCH
WILL BE INELIGIBLE FOR EMPLOYMENT IF THEY HAVE RECEIVED
WILL BE INELIGIBLE FOR EMPLOYMENT IF THEY HAVE RECEIVED A DWI OR
A DWI OR
DUI WITHIN THE
DUI WITHIN THE PREV
PREVIOUS 12 MONTHS.
IOUS 12 MONTHS.
EMPLOYMENT HISTORY
EQUAL OPPORTUNITY AT-WILL AGENCY
List employers in the last three years starting with current or most recent position.
Use back page if necessary
1. COMPANY NAME ____________________________POSITION_______________________
COMPANY ADDRESS _________________________________________________________
START DATE ______________________ LEAVING DATE ___________________________
DUTIES______________________________________________________________________
REASON FOR LEAVING ________________________________________________________
SUPERVISORS NAME__________________________________________________________
2. COMPANY NAME ____________________________POSITION_______________________
COMPANY ADDRESS _________________________________________________________
START DATE ______________________ LEAVING DATE ___________________________
DUTIES______________________________________________________________________
REASON FOR LEAVING ________________________________________________________
SUPERVISORS NAME __________________________________________________________
3. COMPANY NAME ____________________________POSITION_______________________
COMPANY ADDRESS _________________________________________________________
START DATE ______________________ LEAVING DATE ___________________________
DUTIES______________________________________________________________________
REASON FOR LEAVING ________________________________________________________
SUPERVISORS NAME __________________________________________________________
4. COMPANY NAME ____________________________POSITION_______________________
COMPANY ADDRESS _________________________________________________________
START DATE ______________________ LEAVING DATE ___________________________
DUTIES______________________________________________________________________
REASON FOR LEAVING ________________________________________________________
SUPERVISORS NAME __________________________________________________________
REFERENCES
AN EQUAL OPPORTUNITY AT-WILL AGENCY EMPLOYER
1. NAME ____________________________________________________________
PHONE _____________________________________________________________
YEARS KNOWN_____________________OCCUPATION____________________
ADDRESS (STREET, CITY AND STATE) __________________________________
_____________________________________________________________________
2. NAME ____________________________________________________________
PHONE _____________________________________________________________
YEARS KNOWN_____________________OCCUPATION_____________________
ADDRESS (STREET, CITY AND STATE) ___________________________________
_____________________________________________________________________
3. NAME _____________________________________________________________
PHONE ______________________________________________________________
YEARS KNOWN_____________________OCCUPATION______________________
ADDRESS (STREET, CITY AND STATE) ____________________________________
______________________________________________________________________
PERSONAL DATA
EMPLOYMENT REQUIRES A MINIMUM AGE OF 18. ARE YOU 18 OR OLDER? __________
DESCRIBE ANY PROBLEMS THAT WOULD INTERFERE WITH YOUR ABILITY TO PERFORM
THE JOB WHICH YOU ARE APPLYING
ARE YOU AUTHORIZED TO WORK IN THE UNITED STATES? ________________________
ARE YOU A CITIZEN OF THE UNITED STATES? ____________________________________
ARE YOU BILINGUAL? ___________WHAT LANGUAGE? _____________________________
AN EQUAL OPPORTUNITY AT-WILL AGENCY
I AUTHORIZE HIGH SKY CHILDREN'S RANCH TO CONTACT ANY OF MY PREVIOUS EMPLOYERS AND
REFERENCES AND RELEASE THEM AND HIGH SKY CHILDREN'S RANCH FROM ANY LIABILITY
ARISING FROM INFORMATION ABOUT MY EMPLOYMENT. I ALSO AUTHORIZE HIGH SKY CHILDREN'S
RANCH TO HAVE ACCESS TO ANY MEDICAL OR EDUCATIONAL RECORDS AND RELEASE THEM FROM
LIABILITY CONCERNING THESE INQUIRIES.
I UNDERSTAND THAT ANY FALSE ANSWERS OR STATEMENTS, MISREPRESENTATIONS OR
OMMISSIONS MADE ON THIS APPLICATION WILL BE SUFFICIENT FOR REJECTION OF THIS
APPLICATION OR FOR MY IMMEDIATE DISCHARGE IF I AM ALREADY EMPLOYED.
APPLICANTS SIGNATURE _______________________________DATE____________
CRIMINAL HISTORY BACKGROUND CHECK PERMISSION STATEMENT
I, ____________________________________, GIVE HIGH SKY CHILDREN'S RANCH, INC. ,
AT THE TIME OF MY EMPLOYMENT, PERMISSION TO COMPLETE A CRIMINAL HISTORY
BACKGROUND CHECK ON MY BEHALF. I AM ALSO AWARE THAT THIS INFORMATION
IS KEPT IN MY PERSONNEL FILE.
APPLICANTS SIGNATURE_______________________________DATE___________________
CONFIDENTIAL ITY STATEMENT
I UNDERSTAND THAT ALL INFORMATION AND HISTORY OF ANY CHILD OR FAMILY
INVOLVED IN HIGH SKY PROGRAMS IS TO BE RESPECTED AND TRUSTED WITH THE
STRICTEST CONFIDENCE, AND DISCUSSED ONLY WITH APPROPRIATE STAFF. ALL
RECORDS AND DOCUMENTATION ARE TO BE FILED AND LOCKED AND UNAVAILABLE
EXCEPT TO APPROPRIATE STAFF. ONLY GENERAL INFORMATION IS TO BE SHARED WHEN
NEEDED WITH STAFF OR VOLUNTEERS WORKING WITH A CHILD OR FAMILY. TEXAS
DEPARTMENT OF PROTECTIVE AND REGULATORY SERVICES HAS THE RIGHT TO RECORDS
OF THOSE SERVED UNDER THE CONTRACT.
APPLICANTS SIGNATURE_______________________________DATE___________________
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