Application Form - On Our Own Services

Applicant Instructions

Thank you for your interest in employment with our Company. We appreciate your application and look forward to the possibility of you joining our team. This sheet is for your information. Please read it carefully. If you need any assistance or accommodation to facilitate the filling out of this form or during any of the application process, please notify the person who gave you this form and every effort will be made to provide you with the help you request. Be certain that all questions are completely answered. Incomplete information forms will not be considered. Use the abbreviation “N/A” if a particular provision or section in the form is not applicable to you. If you need additional space, you may use the back of the form. This application form is intended for use in evaluating your qualifications for employment. This is not a contract for employment. False or misleading information given in this form or during the interviewing process are grounds for terminating the application process or, if discovered after employment, for terminating employment. Employment decisions are made solely on the basis of qualifications to perform the work for which you are applying. Qualifications include education, training, and work experience. Credentials and experience will be verified through schools, former employers, and any other applicable sources. As an Equal Opportunity Employer, we make decisions to hire and promote without regard to race, color, creed, national origin, sex, physical or mental disability (unrelated to ability to do the job), or age (as defined by law). On Our Own Services Inc., has job readiness and employment programs for people with disabilities. On Our Own Services is here to assist disabled individuals transition into long-term employment. This community rehabilitation program will check criminal records, driver licenses and references on applicants once an employment offer is made. Certain convictions may make you ineligible for employment and/ or lead to summary dismissal. Driving records will be checked on a regular basis on all employees that are required to drive as stated in the job descriptions. If an employee is not insurable, employment may be terminated. Falsification of any information on this application can also lead to summary dismissal or non-employment. All hourly positions have a 180-day Evaluation/Training Period beginning the first day of employment. You should understand that the position for which you are applying is considered at-will, which means that either you or the company can terminate employment for any reason or no reason at any time. No one except the company president has the authority to amend this agreement. We appreciate your interest.

Full Name *

Date

Application for Employment

Position Desired

Date

Full Name *

Email Address *

Street Address

Apartment, suite, etc

City

State

ZIP Code

Phone Number

Social Security Number

Are you over 18 years of age?YesNo

Have you ever filed an application with us before?YesNo

Are you physically or otherwise unable to perform the duties of the job for which you are applying?YesNo

If yes, please describe:

Are you a veteran of the USA Armed Forces?YesNo

If so, what were your years of service?

Is your rating 30% or more?

Are you currently employed?YesNo

May we contact your present employer?YesNo

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?YesNoProof of citizenship or immigration status will be required for employment.

On what date would you be available for work?

AvailabilityFull TimePart TimeShift WorkTemporary

Can you travel if a job requires it?YesNo

Have you ever been convicted or pled guilty or no contest to a felony offense?YesNo

Conviction

For purposes of employment with On Our Own Services, Inc., “convictions” include sentenced to confinement, paid fine, time served, placed on probation (including deferred adjudication) and court-ordered restitution.

City/State

Charge

Please explain:

Note

*Conviction of a felony will not necessarily bar you from employment.

Date

Education

Highest grade completed in school:

Name and address of last school attended:

Vocational or Business schools attended:

List names of friends or relatives now employed by On Our Own Services, Inc.:

Person to contact in case of an emergency:

This information is to facilitate contact in the event of an emergency and is not used in the selection process.

Full Name

Phone

Street Address

Apartment, suite, etc

City

State

ZIP Code

Their place of employment

Work Phone

Street Address

Apartment, suite, etc

City

State

ZIP Code

Their relationship to you

Employment Records

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, national origin or other protected status.

Employment with On Our Own Services, Inc. requires walking, standing, squatting bending, pushing, twisting and lifting of up to 50 pounds. If you have any medical condition that would prevent you from performing these duties, please list below.

Summarize any awards, accreditation, special skills or qualifications you have acquired.

CURRENT OR MOST RECENT EMPLOYER:

Name

Phone

Street Address

Apartment, suite, etc

City

State

ZIP Code

Position/Duties

Dates Employed

Hourly Rate/Salary

Supervisor

Reason for Leaving

CURRENT OR MOST RECENT EMPLOYER:

Name

Phone

Street Address

Apartment, suite, etc

City

State

ZIP Code

Position/Duties

Dates Employed

Hourly Rate/Salary

Supervisor

Reason for Leaving

Complete the following information only if applying for a position that requires use of a vehicle while conducting company business. If hired, your information may be verified with a Motor Vehicle Report.

How many traffic violations have you had during the last two years?

Drivers License Number:

State:

References

Name only those persons who are familiar with your work capabilities. Do not list relatives.

Name

Phone

Street Address

Apartment, suite, etc

City

State

ZIP Code

Position

Years known

Name

Phone

Street Address

Apartment, suite, etc

City

State

ZIP Code

Position

Years known

ATTENTION ALL APPLICANTS

On Our Own Services, Inc. 1s a community rehabilitation program with the mission of providing employment/training for disabled individuals. We provide this training with on the job training. All employees and disabled trainees will receive wages of the federal minimum wage or above. If you are a disabled job trainee your wages will not be reported to the Texas Workforce Commission and On Our Own Services, Inc. will not be on record with TWC as one of your base period employers.

Please list any medications that you take on a regular basis:

Treating Doctor:

Phone

Have you ever been a client of Texas Rehabilitation Commission?YesNo

Have you ever been a client of MHMR?YesNo

If answering yes to either, please give name and phone number of caseworker or office location.

Name *

Date

Authorization for Disclosure of Health Information

Employee Name *

Date of Birth

SS#:

I hereby authorize and request:

To provide:
On Our Own Services, Inc.
2310 McAllister, Houston, TX 77092

I understand that such disclosure will be made for the following purpose(s):Update evaluation / assessmentsProvide documentation of past treatmentCoordinate discharge placement planningFacilitate job placementAssist residential placement searchOther

Copies of this information may include the diagnosis/treatment of drug and alcohol abuse, Acquired Immune Deficiency Syndrome ( AIDS), Human Immunodeficiency Virus (HIV), or psychiatric disorders.

Expiration Date *

Name *

Applicant EEO Data Form

The EEOC recommends that when an employer invites employees to self-identify it explain that “the employer is subject to certain governmental record keeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the employer invites employees to voluntarily self identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the applicable laws, executive orders and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.”

Job Posting Number

Social Security Number

Name

Phone

Street Address

Apartment, suite, etc

City

State

ZIP Code

SexMaleFemale

Birthdate

Applicant Instructions

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