Word Template - Main

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Port Authority of San Antonio Application for Employment Equal Opportunity Employer: This organization does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, or veteran status General Information Position applied for Name Last City First State Date of application Middle Zip Code Address (Street / Route / P.O.Box) Telephone Do you have a valid driver’s license? Can you show proof of eligibility to work in this country? Are you under 18 years of age? Have you been employed under any other name? If yes, please list: _____________________________________ Are you presently in layoff status and subject to recall? Have you ever been employed by this organization? Dates: ______________________________ If you are employed, may we contact your present employer? Yes Yes Yes Yes Yes Yes Yes No No No No No No No Are you related by kinship or marriage to any employee of this organization? If yes, give name & relationship: Yes No Have you been convicted of a felony? (For consideration on certain positions) If yes, please explain: Yes No Date available for work Available for: Full-time Temporary Part-time Shift Education and Training Yes Yes No No Are you a high school graduate? School Name Do you have a GED certificate? City/State City/State . College(s) Attended Location Major Type of Degree Earned Please list any other training and education including Trade School, Business College, etc. which would further qualify you for the position: References Name Address Telephone Employment Record Instructions: Beginning with your most recent job, list below jobs which you have held and specifically describe duties performed. Include any job-related military service assignmewnts or volunteer work. You may exclude organizations which indicate race, color, religion, gender, national origin, disability or other protected status. YOU MAY ATTACH RESUME IF YOU WISH, BUT YOU MUST FILL OUT THIS SECTION FULLY. If you need additional space, please continue on a separate sheet. LIST NAME,ADDRESS, & PHONE NUMBER OF PREVIOUS EMPLOYERS WITH MOST RECENT EMPLOYER FIRST Job Title Employer Name Address Duties FROM TO IMMEDIATE SUPERVISOR LAST SALARY (Hr., Mo., or Yr.) Phone ( ) Reason for Leaving Job Title Employer Name Address Duties Phone ( ) Reason for Leaving Job Title Employer Name Address Duties Phone ( ) Reason for Leaving Job Title Employer Name Address Duties Phone ( ) Reason for Leaving Special Skills/Qualifications Add any additional special job-related skills or qualifications you may have received from your experience (for example, licenses/certifications, foreign language proficiency, office/computer skills.) Applicant’s Statement I certify that all answers given in this application are true and complete. I also understand that any offer of employment may be conditional upon the satisfactory results of drug screening and background checks. I authorize investigation of all statements contained in this application for employment, as may be necessary at an employment decision and do not hold the Organization or any other individual involved in this investigation liable for information obtained in this process. I also understand that false or misleading information given inn my interview or this application may result in elimination from consideration or discharge at any time. I further understand that, if employed, I will abide by all policies, rules, and procedures of the organization. Signature Date

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