San Antonio AIDS Foundation Application for Employment

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1 San Antonio AIDS Foundation Application for Employment The San Antonio AIDS Foundation is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, age, protected veteran or disabled status, or genetic information. (PLEASE PRINT) Position Applied for and Requested Salary Date of Application How did you learn about us? Advertisement Relative Employment Agency Internet Site Walk-In Other Friend Last Name First Name Middle Name Street Address City State ZIP Code Cell If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No Have you ever filed an application with us before? Yes No If Yes, give date: Have you ever been employed with us before? Yes No If Yes, give date: Are you currently employed? May we contact your present employer? If No, when? Y es Yes No No Will you now or in the future require SAAF to commence ( sponsor ) an immigration case in order to employ you (for example, H-1B or other employment-based immigration case)? This is sometimes called sponsorship for an employment-based visa status. Yes No Proof of citizenship or immigration status will be required upon employment. On what date would you be available to work? Are you available to work: Full Time Part Time Shift Work Temporary Are you currently on lay-off status and subject to recall? Yes No Can you travel if the job requires? Yes No Have you ever been involuntarily terminated from a job? Yes No If Yes, please explain San Antonio AIDS Foundation Employment Application WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER

2 Computer Skills: EDUCATION High School Undergraduate College Graduate Professional Other (Specify) Name and Address of School Course of Study Year Completed Diploma/Degree Level Speak, Read and Write Fluently: English Other: Describe any specialized training, apprenticeship, skills and extra-curricular activities. Describe any job-related training received in the United States military. EMPLOYMENT 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, gender, national origin, disabilities, or other protected status. 1. Employer Address Job Title Reason for Leaving 2. Employer Address Job Title Reason for Leaving From To San Antonio AIDS Foundation Employment Application WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER

3 3. Employer Address Job Title Reason for Leaving From To 4. Employer Address Job Title Reason for Leaving If you need additional space, please continue on a separate sheet of paper. List professional, trade, business, or civic activities and offices held. You may exclude memberships which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status: ADDITIONAL INFORMATION Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience. San Antonio AIDS Foundation Employment Application WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER

4 APPLICANT S STATEMENT I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT, IF HIRED, MY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION WOULD BE OF AN AT WILL NATURE, WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER MAY DISCHARGE THE EMPLOYEE AT ANY TIME AND FOR ANY OR NO REASON. IT IS FURTHER UNDERSTOOD THAT THIS AT WILL EMPLOYMENT RELATIONSHIP MAY NOT BE CHANGED BY ANY WRITTEN DOCUMENT OR CONDUCT UNLESS SUCH CHANGE IS SPECIFICALLY ACKNOWLEDGED IN WRITING BY AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. Signature of Applicant Date FOR PERSONNEL DEPARTMENT USE ONLY Arrange Interview? Yes No Remarks: INTERVIEWER DATE Employed? Yes No Date of Employment: Job Title: Hourly Rate/Salary Department Notes: San Antonio AIDS Foundation Employment Application WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER

5 Professional References: 1. Name: : Job Title: Relationship: Years Known: 2. Name: : Job Title: Relationship: Years Known: 3. Name: : Job Title: Relationship: Years Known: 4. Name: : Job Title: Relationship: Years Known:

6 CONSUMER DISCLOSURE AND AUTHORIZATION FORM Disclosure Regarding Background Investigation The San Antonio AIDS Foundation (SAAF) may request, for lawful employment purposes, background information about you from a consumer reporting agency in connection with your employment or application for employment (including independent contractor assignments, as applicable). This background information may be obtained in the form of consumer reports and/or investigative consumer reports (commonly known as background reports ). An investigative consumer report is a background report that includes information from personal interviews, the most common form of which is checking personal or professional references. These background reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the San Antonio AIDS Foundation, throughout your employment or your contract period, as allowed by law. HireRight, Inc. ( HireRight ), or another consumer reporting agency, will prepare or assemble the background reports for the Company. HireRight is located and can be contacted by mail at 3349 Michelson Dr. Suite 150 Irvine, CA 92612, and HireRight can be contacted by phone at (866) Information about HireRight s privacy practices is available at The background report may contain information concerning your character, general reputation, personal characteristics, mode of living, and credit standing. The types of information that may be obtained include, but are not limited to: social security number verifications; address history; credit reports and history; criminal records and history; public court records; driving records; accident history; worker s compensation claims; bankruptcy filings; educational history verifications (e.g., dates of attendance, degrees obtained); employment history verifications (e.g., dates of employment, salary information, reasons for termination, etc.); personal and professional references checks; professional licensing and certification checks; drug/alcohol testing results, and drug/alcohol history in violation of law and/or company policy; and other information bearing on your character, general reputation, personal characteristics, mode of living and credit standing. This information may be obtained from private and public record sources, including, as appropriate: government agencies and courthouses; educational institutions; former employers; and, for investigative consumer reports, personal interviews with sources such as neighbors, friends, former employers and associates; and other information sources. The San Antonio AIDS Foundation will obtain information bearing on your credit worthiness, credit standing or credit capacity and evaluate the applicant for no other purposes outside of those required by law. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the San Antonio AIDS Foundation. San Antonio AIDS Foundation 818 East Grayson San Antonio, TX T (210) F (210)

7 Authorization of Background Investigation I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency such as HireRight, Inc. ( HireRight ), and to the release of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may, as allowed by law, obtain additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period from HireRight and/or other consumer reporting agencies. I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services. I hereby authorize all of the following, without limitation, to disclose information about me to the consumer reporting agency and its agents: law enforcement and all other federal, state and local agencies, learning institutions (including public and private schools, colleges and universities), testing agencies, information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and all other individuals and sources with any information about or concerning me. The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited to, information concerning my employment and earnings history, education, credit history, motor vehicle history, criminal history, military service, professional credentials and licenses. By my signature below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background reports that may be requested by or on behalf of the Company. Applicant Last Name First Middle Applicant Signature Date San Antonio AIDS Foundation 818 East Grayson San Antonio, TX T (210) F (210)

8 DRUG AND/OR ALCOHOL TESTING CONSENT FORM EMPLOYEE AGREEMENT AND CONSENT TO DRUG AND/OR ALCOHOL TESTING I hereby agree, upon a request made under the drug/alcohol testing policy of the San Antonio AIDS Foundation, to submit to a drug or alcohol test and to furnish a sample of my urine, breath, and/or blood for analysis. I understand and agree that if I at any time refuse to submit to a drug or alcohol test under company policy, or if I otherwise fail to cooperate with the testing procedures, I will be subject to immediate termination. I further authorize and give full permission to have SAAF and/or its company physician send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the Company and/or to any governmental entity involved in a legal proceeding or investigation connected with the test. Finally, I authorize the Company to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding or investigation connected with the test. I understand that only duly-authorized company officers, employees, and agents will have access to information furnished or obtained in connection with the test; that they will maintain and protect the confidentiality of such information to the greatest extent possible; and that they will share such information only to the extent necessary to make employment decisions and to respond to inquiries or notices from government entities. I will hold harmless the company, its company physician, and any testing laboratory the company might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol test, even if SAAF or laboratory representative makes an error in the administration or analysis of the test or the reporting of the results. I will further hold harmless the company, its company physician, and any testing laboratory the Company might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of the information is within the scope of this policy and the procedures as explained in the paragraph above.this policy and authorization have been explained to me in a language I understand, and I have been told that if I have any questions about the test or the policy, they will be answered. I UNDERSTAND THAT THE COMPANY WILL REQUIRE A DRUG SCREEN AND/OR ALCOHOL TEST UNDER THIS POLICY WHENEVER I AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN THE ACCIDENT OR INJURY EVENT, AND I AGREE TO SUBMIT TO ANY SUCH TEST. Signature of Employee Date Employee's Name Printed Company Representative Date SAN ANTONIO AIDS FOUNDATION Drug/Alcohol Consent Form

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