SALighthouse

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Application Process

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SAN ANTONIO LIGHTHOUSE EMPLOYMENT APPLICATION

This Company is an Equal Opportunity Employer. As a result, its policy is to afford equal employment opportunity to all individuals regardless of race, color, creed, religion, sex, age, national origin, or disability. Any question on this application relating to the foregoing may be utilized in complying with federal or state record keeping and/or reporting requirements. No question is asked on this application for the purpose of limiting or excluding any applicant's consideration for employment because of the applicant's race, color, religion, sex, national origin, age, or disability. Please answer every question (if not applicable, write "N/A"). If there is an insufficient amount of space on the application to complete your answer to a question, use an additional sheet of paper.

* required fields

DATE OF APPLICATION:

1/5/2009 8:56:16 PM

SOCIAL SECURITY NUMBER:

NAME (Last, First, Middle):

, , *

HOME TELEPHONE NUMBER:

BUSINESS TELEPHONE NUMBER:

ADDRESS (Number, Street):

CITY:

STATE:

ZIP CODE:

LENGTH OF TIME AT THIS ADDRESS:

List previous address if address changed during the past year.

Length of time at this address:

Type of work desired:

Date available for work:

Salary Desired:

Are you 18 years of age or over?

Yes

No*

Do you have the legal right to work in the United States?

Yes

No *

Have you ever applied for employment with this Company before?

Yes

No *

If yes, when did you apply?

Were you hired?

Yes

How were you referred to this job?

Have you ever been convicted of any crime other than a traffic violation?

Yes

No *

If yes, explain
(Note: The conviction or the fact that you have been convicted of a crime by itself,
will not lead to rejection of your application.)

Have you ever held a position that required you to be bonded?

Yes

No *

Have you ever been denied a bond?

Yes

If yes, explain

If job for which you are applying requires driving, do you have a valid operator's license?

Yes

No *

State, Number, Expiration Date

, ,

EMPLOYMENT RECORD:

Starting with present or most recent, list your last four employers.

Employer:

Dates (From, To):

, *

Phone:

Address:

Reason for Leaving:

Position:

Salary:

Type of Work:

Supervisor (Name & Title):

, *

Employer:

Dates (From, To):

Phone:

Address:

Reason for Leaving:

Position:

Salary:

Type of Work:

Supervisor (Name & Title):

Employer:

Dates (From, To):

Phone:

Address:

Reason for Leaving:

Position:

Salary:

Type of Work:

Supervisor (Name & Title):

Employer:

Dates (From, To):

Phone:

Address:

Reason for Leaving:

Position:

Salary:

Type of Work:

Supervisor (Name & Title):

List other work experience, skills, knowledge, talents or other job related experience not covered elsewhere.

EDUCATION

High School Name:

Location:

Subjects Studied:

College Name:

Location:

Degree:

Subjects Studied:

Trade, Business, Correspondence School Name:

Location:

Degree:

Subjects Studied:

U.S. Military or Naval Service:

Rank:

Present Membership in National Guard/Reserves:

Additional comments which you feel would be important in our consideration of your application (for example, hobbies, scholastic or other honors, fluency in foreign languages, etc):

We appreciate your interest in the San Antonio Lighthouse. As a part of our normal procedures for processing an application, an investigative consumer report as defined in Public Law 91-508 may be made. This inquiry typically concerns information on an applicant's character, general reputation, personal characteristics, and mode of living, and may involve personal interviews with neighbors, friends, associates or other persons with whom you are acquainted. Information on the nature and scope of such inquiry, if one is made, is available to you upon written request.

For your application to be considered, you must indicate your agreement with the following statement by signing where indicated. Please read the statement carefully before signing.

I hereby certify that the foregoing statements are true and correct to the best of my knowledge and belief, and hereby grant the San Antonio Lighthouse permission to verify such answers by conducting investigative consumer report on me or by whatever other means it deems necessary. I hereby release the San Antonio Lighthouse and its agents from any and all liability and responsibility, damages, and claims of any kind whatsoever arising from any investigation made of my background, character, or qualifications for employment.

I also understand that any false statement on this application may be considered as a sufficient reason for rejecting this application or, in the event the falsification is discovered subsequent to my employment, for my dismissal.

I further understand that nothing contained in this application or in the granting of an interview creates a contract between the San Antonio Lighthouse and myself for either employment or for the providing of any benefits. No promise regarding employment has been made to me and I understand that no such promise or guarantee is binding upon the San Antonio Lighthouse unless made in writing and executed by its President and me.

Finally, I acknowledge that, if an employment relationship is established, no consideration has been furnished to the San Antonio Lighthouse for my employment other than my services, and I understand I have a right to terminate my employment at any time, and the San Antonio Lighthouse has the same right. If my application for employment is considered favorably, I agree to abide by and comply with the rules of the San Antonio Lighthouse.

Date: 1/5/2009 8:56:16 PM

Signature:

SAN ANTONIO LIGHTHOUSE - APPLICANT SUPPLEMENTAL INFORMATION

QUALIFIED APPLICANTS ARE CONSIDERED FOR EMPLOYMENT, AND EMPLOYEES ARE TREATED DURING EMPLOYMENT, WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, MARITAL STATUS, MEDICAL CONDITION OR HANDICAP. TO HELP US COMPLY WITH FEDERAL/STATE EMPLOYMENT OPPORTUNITY RECORD KEEPING, REPORTING AND OTHER LEGAL REQUIREMENTS, PLEASE ANSWER THE
QUESTIONS BELOW.

THIS POST-EMPLOYMENT INFORMATION FORM WILL BE KEPT IN A CONFIDENTIAL FILE, SEPARATE FROM THE APPLICATION FOR EMPLOYMENT AND YOUR PERSONNEL FILE.

Date: 1/5/2009 8:56:16 PM

Social Security Number:

Name:

Phone:

Date of Birth:

Address:

City:

State:

Zip Code:

Referred by:

Race/Ethnicity: