3607 University Ave.
Wichita Falls, TX 766308 (Map)
940-691-5024
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*Required fields
Name*:

Email*:

Phone*:

Address*:

Please list your last 3 employers. Most recent first.

Employer:

Dates Employed:

Address:
Supervisor:
Salary/Rate of Pay:

Phone:

Work Duties:
Reason for leaving:


Employer:

Dates Employed:

Address:

Supervisor:

Salary/Rate of Pay:

Phone:

Work Duties:

Reason for leaving:



Employer:

Dates Employed:

Address:

Supervisor:

Salary/Rate of Pay:

Phone:

Work Duties:

Reason for leaving:



Do you have a high school diploma or its equivalency?

Are you currently employed?

Can we contact your present employer?

On what date are you available for work?

Would you be available for a Full Time, Part Time, or Substitute position? Please list which positions.

Have you ever been convicted of : A.) A felony or misdemeanor classified against a person or family? B.) A felony violation of any law intended to control the possession or distribution of any substance included as a controlled substance in the Texas Controlled Substance Act?

If yes, please explain:


Please write a small paragraph about yourself.


Emergency Contact Name:

Emergency Contact Phone:

Emergency Contact Relationship:


I hereby declare that all information in this application is true to best of my knowledge:
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Date


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