Employment Step 1 of 8 12% The information requested on this application must be completed thoroughly and accurately. All information supplied will be verified for accuracy. Inaccurate information could result in the withdrawal of an offer or termination of employment. Southwest Center is an Equal Opportunity Employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, national origin, ancestry, religion, age, citizenship, sex, marital or veteran status, national origin, disability or handicap, genetic information, sexual orientation or any other basis prohibited by applicable law. Southwest Center also takes affirmative action to employ, and advance in employment, qualified women, minorities and covered veterans. Southwest Center also makes reasonable accommodations for qualified individuals with disabilities in accordance with the Americans with Disabilities Act (ADA), ADAAA, and applicable state laws.Name* First Middle Last Email* Present Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Desired Position*- Please Choose -LPNAuditorDriverDSP – ResidentialDSP Line LeadShipperFull Time or Part Time*Full TimePart TimeEitherDesired Salary*Willing to Travel?*YesNoAre you at least 18 years or older?*YesNoAre you either a US Citizen or do you currently have unrestricted authorization to work for any employer in the US?*YesNo Employment HistoryList current or most recent employer first. Please note that base salary does not include bonus, commission, benefits, overtime, or other salary incentives. Identify all period of time during which you were employed or attending school (e.g., military service). Please account for your entire employment history for the past seven years (including volunteer positions). Name of Employer*Address* Street Address City State / Province / Region ZIP / Postal Code Supervisor's Name* First Last Supervisor's Title*Supervisor's Phone*Description of Duties*Your Position*Hire Date* Term Date* Starting Base Salary*Current/Last Base Salary*Reason for Leaving*Overtime/Bonus/Commission*May we contact your current employer?*YesNoDo you wish to add another Employer?*YesNo Name of Employer*Address* Street Address City State / Province / Region ZIP / Postal Code Supervisor's Name* First Last Supervisor's Title*Supervisor's Phone*Your Position*Description of Duties*Hire Date* Term Date* Starting Base Salary*Current/Last Base Salary*Reason for Leaving*Overtime/Bonus/Commission*Do you wish to add another Employer?*YesNo Name of Employer*Address* Street Address City State / Province / Region ZIP / Postal Code Supervisor's Name* First Last Supervisor's Title*Supervisor's Phone*Your Position*Description of Duties*Hire Date* Term Date* Starting Base Salary*Current/Last Base Salary*Reason for Leaving*Overtime/Bonus/Commission*Do you wish to add another Employer?*YesNo Name of Employer*Address* Street Address City State / Province / Region ZIP / Postal Code Supervisor's Name* First Last Supervisor's Title*Supervisor's Phone*Your Position*Description of Duties*Hire Date* Term Date* Starting Base Salary*Current/Last Base Salary*Reason for Leaving*Overtime/Bonus/Commission*If you have selected No, please note that your current Employer will be contacted if you have been offered and accepted a position and after you have given notice of resignation. EducationName of High School*Address of School* City State / Province / Region Did you graduate?*YesNoName of College/UniversityAddress of School City State / Province / Region Areas of Study# Years CompletedDid you graduate?YesNoDegree AwardedGraduate, Business, or OtherAddress of School City State / Province / Region Areas of Study# Years CompletedDid you graduate?YesNoDegree AwardedProfessional Licenses or Certifications:Relevant Office Skills/SoftwareLanguage Proficiencies (read/speak/write): Referred by:*Job PostingInternetCollegeJobFairCurrent employee referralFormer employee referralAre you related to a current employee of Southwest Center?*YesNoName of employee to which you are related*This information will be used for job placement purposes, consistent with applicable law.Have you ever been employed by Southwest Center?*YesNoPlease provide the dates you were employed:*Have you ever been convicted of or have you pleaded guilty to a felony or misdemeanor (exclude minor traffic offenses or convictions which have been sealed or expunged)?*YesNoPlease explain*A conviction record will not necessarily be a bar to employment. This information will be used only for job-related purposes and only to the extent consistent with applicable law. Terms of SubmissionFalse Application: False answers or omissions to questions or false statements or omissions made on this application, during interviews or in your resume, or in supplement thereto, including, but not limited to, with respect to duties, responsibilities, job title, education or salary and bonus information, may invalidate your application or, if you are hired, may be grounds for discharge from employment. Employment is “At Will”: Employment at Southwest Center is for an indefinite and unspecified duration. If you are hired, you may leave employment at will, and the Organization may discharge you or any or all other employees at any time, without notice, and for any reason not prohibited by law. The preceding sentence may not be changed or superseded by any oral or written statement, Organization manual, policy, or benefit plan, and may only be changed or superseded by: 1.) A special written agreement specifying in detail the duration and terms of your employment, which has been executed by you and an executive officer of Southwest Center or 2.) A written, formal restatement of the employment relationship by an executive officer of the Southwest Center. The Organization disavows any oral or any other written statements to the contrary, and you should not now or in the future rely on any such statements with respect to your employment. Code of Conduct: If hired, the Southwest Center will require you to comply with its Code of Business Conduct & Ethics. The Code addresses issues such as but not limited to: workplace principles; potential and actual conflicts of interest and corporate opportunities; protection and proper use of Southwest Center assets; compliance with laws and regulations; questionable payments; political contributions; securities transactions; directorships and positions with other organizations and businesses; and media relations. You will receive a hard copy summary of this Code along with any formal offer of employment. Handbooks, Manuals, Policies, Procedures, Benefits, Etc.: The Southwest Center may, at its sole discretion, hold in abeyance or revoke, amend or modify, abridge or change any benefit, policy, procedure, practice, condition, or process affecting employees. Descriptions of these that may be contained in any handbook, manual, policy, and the like are for informational purposes and are not intended to be, nor should they be construed to constitute, an employment contract, an offer of initial or continuing employment, or a promise or a guarantee made by the Organization. Immigration Reform and Control Act (IRCA): This federal law prohibits the employment of unauthorized aliens and further requires that, if you are hired, Southwest Center will verify your identity and your authority to work in the United States on a Form I-9, even if you are a U.S. citizen. New employees must complete on or by day one and the form must be complete within three days from when you begin employment. You are responsible for obtaining and providing the documentation required to perform the verification. Failure to provide required information will result in termination of employment. Information concerning the verification procedure and requirements is available upon request. Authorization: I voluntarily give Southwest Center or its authorized agent the right to make any investigation of my background deemed necessary by them including, but not limited to, my present and former employment, my educational background, my credentials, and my personal or professional references; and I hereby authorize those persons or institutions contacted by Southwest Center or its agents to provide the information requested, including the reasons for termination of my employment, work performance, and other information pertinent to my qualifications for employment. Any offer of employment is contingent upon the successful completion of the Southwest Center’s total pre-employment screening process. Upload Resume I have read the Terms of Submission NameThis field is for validation purposes and should be left unchanged.