SERVICES FOR THE ELDERLY, INC.
Initial Application Packet

Thank you for applying with Services for the Elderly, Inc. Please complete the application attached to this cover sheet. It must be complete or it will not be processed.

When we match you with a client, we will call you to attend an orientation. At this time, please bring your current valid Driver's License/Identification Card and your Social Security.

Failure to attend the orientation may result in the client being matched with a different attendant. You will then have to wait for another suitable client to become available.

Your application will be held for 90 days. After that time, it will be necessary for you to complete a new application.

Type of Transportation: Bus ________ Car __________

Language: English _______ Spanish ________ Other________

Days you are available to work:
Mon___ Tues___Wed___Thurs___ Fri___ Sat___Sun___
(Yes/ No)

Time you are available to work? __________a.m. to _________p.m.

Where are you willing to work? North____ South____ East____ West____ All areas____

Signature_______________________Date_______________

 

SERVICES FOR THE ELDERLY INC.
EMPLOYMENT APPLICATION - EOE
(Application de Empleo)
2200 East M.L.K. Jr. Blvd.
Austin, Texas 78702-1344

Name (Nombre):_____________________
Social Security (Seguro Social) :___________
Date (Fecha):______________

Address (Dirección):___________________
Telephone (Teléfono): (__)_______ Other (Otro#): (_)_____

City (Cuidad):________ State (Estado):____
Zip Code (Código Postal): ________

Position Applied For (¿Que tipo de trabajo busca?):
- Attendant (Proveedor)____ -Other (Otro): ____

Have you previously worked for Services for the Elderly, Inc.?
(¿Ha trabajado antes con esta agencia?) Yes __ No__
If Yes (Si), when (Fecha)? ________

What form of transportation will you use?(¿Que clase de transporte usara?) Bus (Autobús) ___Car (Auto) ___Other (Otro):______

Are you 18 years or older? (¿Tiene 18 años de edad?) _____

Have you ever been convicted of a Felony? Yes___ No ____
(¿Tiene antecedentes penales?) (Sí)

If yes, explain in full (¡Explíquese Vd!)

 

Education Record
(Educación)

High School (Escuela Secundaria)__________ Year (Año) ___

CNA ____________________________Year (Año)_____

Expiration Date: (Fecha de vencimiento) _________

Other (Otro)______________________ Year (Año) _____

Type(Clase de educación) :_________

Special Skills/Languages (Habilidades/Idiomas) ________

Languages spoken (Cuales idiomas habla) :__________

Speak(Hablar) __________ Read (Leer)________

Write (Escribir) ___________

List any special skills you possess and/or equipment or office machines you can operate: (¿Escribe su habilidades, o que máquina de oficina puede operar?)

 


References (Non-Related) Referencias (sin relación familiar)

Name (Nombre) ___________
Address (Dirección)________________________
Phone (Teléfono)# ______________
Occupation (Ocupación) ________________

Name (Nombre) ___________
Address (Dirección)________________________
Phone (Teléfono)# ______________
Occupation (Ocupación) ________________

Name (Nombre) ___________
Address (Dirección)________________________
Phone (Teléfono)# ______________
Occupation (Ocupación) ________________

 

SERVICES FOR THE ELDERLY, INC.
Employment History (Empleo anterior)

Previous Employment (Empleo anterior) :_______________

Supervisor (Supervisor) :_______________________________

Employers Address (Dirección):___________________________

Employer's Phone #: (Teléfono) _______________

Describe duties: (Clase de trabajo) ____________________________________________________

Employment Dates (Fecha de empleo) From (Desde): ____To (Hasta):____

Hourly Rate (Paga por hora):_______

Reason for Leaving: (Razón que dejo el trabajo) ____________________________________________________

Previous Employment (Empleo anterior) :________________

Supervisor (Supervisor) :_______________________________

Employers Address (Dirección):___________________________

Employer's Phone #: (Teléfono) _______________

Describe duties: (Clase de trabajo) ____________________________________________________

Employment Dates (Fecha de empleo) From (Desde): ____To (Hasta):____

Hourly Rate (Paga por hora):_______

Reason for Leaving: (Razón que dejo el trabajo)