Last Name   First Name  
Middle Name  

Present Address   
City   Zip Code     

Alternate Address     
City  Zip code    

Alternate Telephone Number

Referred by Employment     

Date Available for Employment                  

Eligible to Work in United States?
                                                     (yes or no)    

Position (s) Applied For     

Starting Salary  

Geographical Locations Preferred 

Are you willing to Travel? 
                                         (yes or no)      

Work Overtime?     
                             (yes or no)   

Transfer?                              
                    (yes or no)  

Are you at least 18 years of age?        
                                                      (yes or no)   

Have you previously worked for our company?
                                                                       (yes or no) 

       Drivers License #:  

Must be completed in its entirety, including salary information.

Present (or last) Company Name  Address 
City    State    

May we contact?   Yes No    

Job Title   
Dates (MO/YR to (MO/YR): From - To  

Supervisor Name /Phone Number           

Starting Base Salary$  

Current Base Salary $  Reason for Leaving 

Brief description of duties (include number of persons supervised, if applicable)

Previous Employer Company Name     

Address   City   State 

Job Title      
Dates (MO/YR to (MO/YR): From - To   

Supervisor Name /Phone Number                                                        

Starting Base Salary $  Current Base Salary $  

Brief description of duties (include number of persons supervised, if applicable)

Previous Employer Company Name     

Address   City   State  

Job Title      
Dates (MO/YR to (MO/YR): From - To   

Supervisor Name /Phone Number   

Starting Base Salary $ Current Base Salary$  

Reason for Leaving      

Brief description of duties (include number of persons supervised, if applicable)

Previous Employer Company Name                                 

Address  City   State  

Job Title  
Dates (MO/YR to (MO/YR): From - To 

Supervisor Name/ Phone Number 

Starting Base Salary $   Current Base Salary $ 

Reason for Leaving    

Brief description of duties (include number of persons supervised, if applicable)

HOUSTON FOOD BANK IS AN EQUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE
AGAINST APPLICANTS OR EMPLOYEES ON THE BASIS OF RACE, COLOR, SEX, AGE, RELIGION,
NATIONAL ORIGIN, OR DISABILITY.

Education 

Military

Active Duty Branch                              Dates of Active Duty         Highest Rank Attained
                     

Reserve Status                                                      Reserve Branch
                                  

Criminal

Have you ever been convicted of a felony offense?   
                                                                             (yes or no)
If yes, list date, charge and city convicted.  Include all convictions, civilian or military. 
This information will not be used as an automatic disqualification from employment consideration. 
  

Skills

List office skills, trades, abilities or license certifications that may be beneficial
in the job for which you are applying.
   
Foreign Languages:                                                  Degree of Proficiency:
                                 Speak  Read  Write 

References

Name and Association                 Occupation            Address         Phone       Years known 
 

Name and Association                 Occupation            Address         Phone        Years known
 

Name and Association                 Occupation            Address         Phone        Years known
 

APPLICANT'S STATEMENT (Applicant must review and sign below.)

I affirm that I have read and fully completed both sides of this application and all information
as written above is true and correct, and I acknowledge that I may be terminated at any time
if any information I supply is false. I acknowledge that this application will remain active
for no more than 45 days. If I wish to be considered for employment after this 45 day period,
I will reapply. I understand that if I am employed by Houston Food Bank my employment
and compensation can be terminated, with or without cause and with or without prior notice,

I authorize the references listed on this application to give you any and all information
concerning my previous employment and pertinent information they may have, personal
or otherwise,and release all parties from all liability for any damage that may result from
furnishing same to you.

I hereby grant Houston Food Bank the right and privilege to withhold, retain or deduct an amount
up to and including the total amount of indebtedness, advances, charges for personal purchase
on Company accounts, or any other amounts owed to Houston Food Bank, or any of its affiliates,
subsidiaries, or divisions, from any salary, wages, commissions, or any other debt owed by me
to the Company.

I understand that I am required to abide by all rules and regulations of the Company, I acknowledge
that these policies and procedures, and any benefits or other terms and conditions of my
employment, may be changed, interpreted, withdrawn or added to by the Company at any
time without prior notice to me.

SIGNATURE OF APPLICANT      DATE