Equal access to programs, services and employment is available to all persons. Those applicants requiring
reasonable accommodation to the Application and / or interview process should notify a representative of the
Human Resources Department.
If you are under the age of 18, and it is required, can you furnish a work permit?
I am certifying that I am able to perform the essential function of the job, for which I applying, with or without reasonable accommodation, as described to me during the application process and through any printed material made available to me.
Have you ever been employed here before? If yes, give dates and positions.
Are you legally eligible for employment in this country?
ANSWERING YES TO THESE QUESTIONS DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT, FACTORS SUCH AS DATE OF
THE OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION, REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN
Provide the following information of your past two (2) employers, starting with the most recent.
Skills and Qualifications
Summarize any training, skills, license and/or certifications that may qualify you as being able to perform
job-related functions in the position for which you are applying.
I certify that all information I have provided in order to apply for and secure work with tiie employer is
true, complete and correct. I understand that consideration for employment is conditioned upon the results of
a reference check, and that the company Disability Resources, Inc. is authorized to investigate all
statements by the applicant upon the application and to contact former employers and references.
I understand that any information provided by me that is found to be false, incomplete, or misrepresented in
any respect will be sufficient cause (1) to cancel further consideration of this application or (2) immediate
discharge from the employer service, whenever it is discovered.
I understand dial a drug lest may be required after an offer of employment has been made as a condition of
I understand that this application will remain current for only 60 days.
I understand that I am an “at will” employee, that either I or the employer can terminate my employment for
any reason, with or without notice or cause.
I also understand that if I am hired, I will be required to provide proof of identity and legal
authorization to work in the United States and that federal immigration laws require me to complete a DHS
Employment Eligibility Verification Form.
This agreement supersedes any and all agreements, written or oral, regarding your employment. Your
employment will be governed by the laws of Texas.
Disability Resources, Inc.
AUTHORIZATION FOR CONSENT FOR RELEASE OF INFORMATION (PLEASE READ CAREFULLY)