Employment Application

Employment Form

Personal Information

First Name

Middle Name

Last Name

Address

City

State

Zip Code

Primary Phone Number

Secondary Phone Number

Email Address

Resume Upload (optional)

Choose File

Employment Desired

Position applied for

How did you hear about this position?

Date available for work

Desired # of hours and Days, Times, etc.

Education

High School

Name and Address of School

Course of Study

Total Years of Study

Degree/ Diploma

Undergraduate College

Name and Address of School

Course of Study

Total Years of Study

Degree/ Diploma

Graduate/ Professional

Name and Address of School

Course of Study

Total Years of Study

Degree/ Diploma

List any military service or other education not listed above which may help qualify you for this position:

Employment History

List below all present and past employers over the past ten years, starting with your most recent employer. Account for all periods of unemployment. You may attach a resume as a supplement to this section, but please provide as much specific information about former employers as possible (such as name, complete addresses, contact information). This information might be used as part of a background/ reference check/employment verification. If you submit a resume to supplement this section, it shall become an attachment to and a part of this application.

Employment History 1.

Employer

Start date

End date

Address

City

State

Zip Code

Supervisor name

Phone Number

Email Address

Job Position

Reason For Leaving

Job Description

Employment History 2.

Employer

Start date

End date

Address

City

State

Zip Code

Phone Number

Supervisor name

Email Address

Job Position

Reason For Leaving

Job Description

Employment History 3.

Employer

Start date

End date

Address

City

State

Zip Code

Phone Number

Supervisor name

Email Address

Job Position

Reason For Leaving

Job Description

Show Employment History 4

Yes

Show Employment History 5

Yes

Employment History 4.

Employer

Start date

End date

Address

City

State

Zip Code

Phone Number

Supervisor name

Email Address

Job Position

Reason For Leaving

Job Description

Employment History 5.

Employer

Start date

End date

Address

City

State

Zip Code

Phone Number

Supervisor name

Email Address

Job Position

Reason For Leaving

Job Description

Additional Information

List any professional, trade, business or civic activities and offices held. You may exclude membership that would reveal gender, race, religion, national origin, ancestry, age, disability or any other protected status.

List all languages that you can speak, read and write. (Please include your fluency level of English):

Identify formal job training that relates to this position (for driving positions, this may include training such as first aid, defensive driving, passenger assistance, etc.):

Identify what skills or certification you possess related to this position:

Have you ever been employed with SPAN, Inc. before?

Yes

If Yes, when?

Do you have any friends or relatives employed by SPAN, Inc.?

Yes

If Yes, please provide their names and relationship to you:

Are you currently employed?

Yes

May we contact your employer?

Yes

Are you currently on “lay off” status and subject to recall?

Yes

If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.?

Yes

Are you able to perform all of the essential functions of the job for which you are applying with or without reasonable accommodation?

Yes

If hired, do you have a reliable means of transportation to and from work?

Yes

If driving is a requirement of the position applied for, have you been convicted of, or pled “guilty” or “no contest to,” Driving Under the Influence (“DUI”) or Driving While Intoxicated (“DWI”)?

Yes

N/A

If driving is a requirement of the position applied for, do you have a valid Texas Driver License?

Yes

N/A

If driving is a requirement of the position applied for, do you have a valid Commercial Texas Driver License with a Passenger Endorsement?

Yes

N/A

References

List below three persons not related to you who have knowledge of your work performance within the last 5 years.

Reference 1

Name

Occupation

Company name

Address

Telephone

E-mail

Relationship & years acquainted

Reference 2

Name

Occupation

Company name

Address

Telephone

E-mail

Relationship & years acquainted

Reference 3

Name

Occupation

Company name

Address

Telephone

E-mail

Relationship & years acquainted

Additional Space

Additional space provided to expand on any points or questions asked previously in this application

Please read each statement closely and initial after each before signing at the bottom to acknowledge your understanding.

Equal Employment Opportunity Statement

Span, Inc. is committed to complying with all federal, state, and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The Company desires to maintain a work environment that is free of harassment and discrimination due to race, color, religion, sex (including sexual orientation, gender identity, or pregnancy), national origin, older age (beginning at age 40), disability, or genetic information (including family medical history), or any other status protected by federal, state, or local laws. The Company will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the Company.

Discrimination and Sexual Harassment Policy Statement

Span, Inc. will not tolerate any form of unlawful discrimination or harassment, including sexual harassment. Any employee who engages in unlawful discrimination or harassment, sexual or otherwise, will be subject to appropriate discipline, up to and including termination.

Disclosure to Applicants Concerning Drug/Alcohol Testing and Background Screening

Subject to the terms and conditions stipulated by the Department of Transportation and the Drug and Alcohol Policy of Span, Inc., you may be given a drug/alcohol test as a condition of employment. Your refusal to timely submit to a drug/alcohol test or your failure to pass such a test means you will likely become ineligible for employment by SPAN, Inc. Additionally, all employees of Span, Inc. will be required to undergo and pass a criminal background screening. Some positions may require further periodic screenings. I understand that depending on the results of the background screening and the position for which I am applying, I may be disqualified as an eligible candidate. I further understand that if I become an employee of Span, Inc. future results of any drug or criminal background screening may make me ineligible for employment and be a cause for termination, depending on the results and the position in which I am employed.

Complete and Accurate Information

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

At-Will Employment

I understand that my submission of this application, does not obligate Span, Inc. to hire me now or in the future. I further understand and agree that if I am employed, my employment will be “at-will”, which means that Span, Inc. may terminate the employment relationship at any time, with or without cause and with or without notice. Likewise, Span, Inc. will respect my right to terminate my employment at any time, with or without cause and with or without notice.

Medical Examination

I understand that if offered certain positions with Span, Inc., I might be required to pass a medical examination to remain eligible for employment.

Investigation Authorization

I authorize investigation into all statements and references contained in this application.

I have read and agree with the statements above made by Span Inc..

Signature

Sign Here

Date

	Fluent	Good	Fair
Speak
Read
Write