TBI Employment Application Step 1 of 6 16% Position You're Applying ForDate of Application Month Day Year Referral Source Advertisement Friend Relative Other Please describe other sourceYour Personal InformationYour Name(Required) First Middle Last Your Email Address(Required) Enter Email Confirm Email Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Your Phone(Required)Social Security NumberTexas Driver's License NumberBest Time To Call YouWhen is the best time for us to reach you via telephone?MorningsEarly AfternoonLate AfternoonEarly EveningEmergency ContactIn case of emergency, you may contact the following person(s) at the phone & address below. Previous EmploymentAre You Employed Now? Yes No May We Contact Your Present Employer? Yes No Date Available For Work Month Day Year Have You Ever Been Employed Here Before? Yes No Give Date Of Your Last Employment Here Month Day Year Are You Available To Work Full Time Part-Time Temporary Shift Work Are You On A Lay-off And Subject to Recall? Yes No Have You Been Convicted Of A Felony Within The Last 7 Years? Yes No Please Explain Your ConvictionYour Previous EmployersPlease list your previous three employers, the dates you worked and the position you heldEmployerPhoneAddressDates EmployedJob TitleHourly Rate/SalarySupervisor NameReason for Leaving Add Remove EducationElementary (K-8)Please list each school's name and years completed.High School (9-12)Please list each school's name and years completed.College/UniversityPlease list each school's name, years completed, and course of study.Graduate/ProfessionalPlease list each school's name, years completed, and course of study. Also describe any specialized training, apprenticeships, skills, and extra-curricular activities. Your Skills And QualificationsSummarize Special Skills and Qualifications Acquired From Employment or Other ExperienceAre You A Veteran Of The U.S. Military Service? Yes No What Branch Did You Serve Under?Are You Willing To Abide By The Rules Of The TBI Drug & Alcohol Policy? Yes No List Languages You Speak, Read, And/Or Write And Level of KnowledgeHave you been given a written job description for the job for which you are applying?If you have not received a written job description, please ask the person from whom you received this application. Yes No Physical RequirementsAre you capable of working outside for 9 hours per day, 5 days per week, in any weather conditions? Yes No Can you accomplish all of the tasks required for the position you are applying for? Yes No Can you perform the physical and mental requirements of the position you are applying for? Yes No Can you work safely within the described environment and conditions described for the position you are applying for? Yes No Can you travel to the distant job sites that may be required for the position you are applying for? Yes No If your answer is no to any of the above, please explain in detail. AgreementsAt Our Request Would You Be Willing to Submit To A Polygraph Test And/Or Urinalysis For Matters Concerning Company Business Only. Yes No Applicant's StatementI certify that answers given herein are true and complete to the best of my knowledge, and that any additional resume sheets that I may have attached repersent truthful information to be used in considering my application. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that my employment is an employment at will and that I am required to abide by all rules and regulations of the company, including but not limited to, the Company safety policy and Company alcohol and drug policy, which have been discussed thorougly. I agree with the above statement.SignatureDate Signed Month Day Year
