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Submit a General Application

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Contact Information
* Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Application Information
* How did you hear about us?:
Longhorn Associate Name:
If other, explain here:
Attachments
You can optionally include the following attachments with your application. Please note that you must fill out the application completely, even if you attach a resume.
Resume:
Supported formats: Word, PDF, RTF, Text, and HTML.
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Application for Employment
Position Information
* Salary Desired:
* How did you hear about this position:
* Have you ever applied here before? Yes   No
If yes, when?
If yes, give your name(s) if different from the one given on this application:
* Are you applying for: Full time   Part time   Regular   PRN (as needed)
* Date available for work:
* Would you consider working any shift? Yes   No
* Shift Preference: 1st   2nd   3rd
* Would you work weekends? Yes   No
* Would you work holidays? Yes   No
* Rotating Shifts or On-Call Shifts?: Yes   No

Days/hours available to work:

Mon Tues Wed Thurs Fri Sat Sun

General Information
* Are you legally authorized to work in the United States?: Yes   No
(Proof of work authorization will be required upon employment)

If the position you are applying for requires a driver's license, do you possess a valid driver's license? Yes   No
If yes, State:
If yes, License No:

* Do you have relatives working for Longhorn Village or CRSA EMPLOYMENT SERVICES? Yes   No
If yes, please complete the following:
Name:
Department:
Relationship:

What does customer service mean to you?:

Background Information
* Have you ever been convicted of any crime?: Yes   No
If yes, please briefly describe the nature of the crime(s):
Date:
Legal disposition of the case:
Place of conviction/address:
Are you currently out on bail or released on your own recognizance pending trial? Yes   No

This company will not deny employment to any applicant solely because the person has been convicted of a crime. The company, may, however, consider the nature, date, and circumstances of the offense as well as whether the offense is relevant to the duties of the position applied for.

Other Qualifications
Job-related training courses (give title and year):
Job-related skills (other languages, computer software/hardware, tools, machinery, typing speed, etc):
Job-related certificates and licenses (current only):

Work History
Include all of your employment experience in the last 7 years, listing the most recent position first. Provide your complete employment history even if you attach a resume.

Company Address Phone Supervisor
Job Title & Department Salary Dates May we Contact
Start:
End: 		Start:
End: 		* Yes
No
Responsibilities Reason for Leaving


Company Address Phone Supervisor
Job Title & Department Salary Dates May we Contact
Start:
End: 		Start:
End: 		* Yes
No
Responsibilities Reason for Leaving


Company Address Phone Supervisor
Job Title & Department Salary Dates May we Contact
Start:
End: 		Start:
End: 		* Yes
No
Responsibilities Reason for Leaving


Company Address Phone Supervisor
Job Title & Department Salary Dates May we Contact
Start:
End: 		Start:
End: 		* Yes
No
Responsibilities Reason for Leaving


* Have you ever been involuntarily terminated? Yes   No
Please explain any gaps of more than six months in employment

Education
* Select highest level completed:

Last High School or GED school. Give the school's name, City, State, Zip code (if known)

School City State Zip

Colleges and universities attended
Name Address (City & State) Major(s) Date of Graduation

Professional Licenses/Certifications (Required if you are applying for Nursing or C.N.A. position)
Type State Issued Date Issued Expires License Number

Professional References
Name Company Relationship Phone
* * * *
* * * *
* * * *

Certification and Agreement
I certify that all information given on this application and any accompanying documents is true, complete and correct to the best of my knowledge and belief and is made in good faith. I understand that misinformation on the application could be considered falsification and would be grounds for employment action.

* Signature of Applicant (type name):
* Date:
General Questions
* Are you authorized to work in the United States for any employer?
Yes
No
* Do you have a bachelors degree?
Yes
No
* Are you 18 or older?
Yes
No
* Would you be able and willing to travel as needed by the job?
Yes
No
* Have you ever been convicted of a felony?
Yes
No
If Yes, please explain.
* What minimum salary do you require?
* What type of job are you seeking?
Full-time
Part-time
Temporary or Seasonal
LHV Affidavit & Pre-employment Inquiry Release

To complete the application process your signature, along with the date of the application, is required on the Affidavit and Pre-Employment Inquiry Release form on the following page. Because of the personal, sensitive information required to successfully complete pre-employment inquiries, the Affidavit is separated from the Application before it is forwarded to the hiring manager for consideration.

PLEASE READ CAREFULLY BEFORE SIGNING the Affidavit and Pre-Employment Inquiry Release. This application will be considered active for twelve (12) months from the date filed. If you are hired, it becomes part of your employment record.

I certify that all information given on this application and any accompanying documents is true, complete and correct to the best of my knowledge and belief and is made in good faith.

In connection with my employment with Longhorn Village/CRSA Employment Services, I understand that investigative background inquiries are to be made of myself including Criminal, Driving, Schools, Credit, and other reports. These reports will include information as to my character, work habits, performance and experience along with reasons for termination of past employment from previous employers. Further, I understand that information from various Federal, State, Consumer, and other agencies which maintain records concerning my past activities relating to my Driving, Criminal, Civil and other experiences as well as claims involving me in the files of insurance companies will be requested.

I authorize all schools which I attended and all previous employers to furnish to Longhorn Village/CRSA Employment Services or their agent, my record, reason for leaving and all information they may have concerning me, and hereby release them and Longhorn Village/CRSA Employment Services from all liability for any damage whatsoever.

By signing this application, I authorize the Company to make investigations and indicate my awareness that false statements or failures to disclose certain information may be sufficient to disqualify me for employment, or if employed, may result in my dismissal.

I understand that proof of identity and work authorization will be required upon employment in accordance with federal regulations. In the event of my employment by Longhorn Village/CRSA Employment Services, I agree to abide by all present and subsequently issued rules of Longhorn Village/CRSA Employment Services.

I also understand that if employed by Longhorn Village/CRSA Employment Services any claim or lawsuit relating to my service must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary.

I understand that my employment is at will and that either party is free to terminate the employment relationship at any time without cause. Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Longhorn Village/CRSA Employment Services, or otherwise change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the Executive Director of the Company.

* First Name:
Middle Name:
* Last Name:
* Social Security Number:
* Date of Birth:
* Cell Phone Number:
* Home Phone Number:

* Signature of Applicant (type name):
* Date:
Voluntary Self-Identification

Longhorn Village is subject to certain governmental recordkeeping and reporting requirements in order to comply with various civil rights laws and regulations. In order to comply with these requirements, Longhorn Village invites all candidates to voluntarily self-identify their gender and race/ethnicity. Completion of this information is voluntary and refusal to provide it will not adversely affect any hiring or other employment related action.

Information gathered during the self-identification process will be kept confidential and is maintained separately from the application and other employment records.

Gender
Male
Female
Race/Ethnicity:  Please check one of the descriptions below corresponding to the ethnic group with which you identify
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless or race.
Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.
White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.
I do not wish to provide this information

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