Application for Employment


Dear Applicant:


Thank you for your interest in employment with T.E.A.M. ABILITIES.  The attached application for completion should be returned to the office location listed on the first page of this application.


The following completion requirements must be followed:

 

1.    Use Black Ink or Type.

    

2.    Be specific as to the position for which you are applying.

    

3.    List all education attainments, diplomas, certifications and/or licenses.

    

4.    Employment history for the last five years should include names and mailing address of employer, dates of employment, specific job duties and reasons for separation.

    

5.    Documents that must be provided with your application include:


a.    Valid TX Driver’s License (we will make a photocopy of your license for our records)


b.    Social Security Card (we will make a photocopy of your card for our records)


c.    High School diploma or GED (we will make a photocopy for our records)


d.    3 letters of reference (we must have letters on file, not just names & numbers)


Your application WILL NOT be accepted without the documents listed above in bullet 5.  

NO EXCEPTIONS!

    

The foregoing list is mandatory for your application to be considered active.  Resumes and any further information, which better indicates your work history and skills, are encouraged.  


Again, thank you for your interest and we look forward to processing your application.


T.E.A.M. ABILITIES, INC., is an equal opportunity/affirmative action employer.  All qualified applicants will be considered without regard to age, race, color, sex, religion, national origin, marital status, ancestry, citizenship, veteran status, sexual orientation of preference, or physical or mental disability.

TEAM Abilities Employment Prescreening Assessment



1.    What hours can you work?

    

2.    Why do you want to take care of people?

    

3.    Have you ever given anyone an adult with IDD bath?  Explain


4.    Are you able to consistently lift/transfer 100lbs plus, daily? Explain


5.    Have you worked with/changed a colostomy bag? Explain

    

6.    Have you ever helped anyone toilet themselves? Explain

    

7.    Have you ever taught anybody else how to do something? Explain

    

8.    How do you feel about doing housework?   (Specifically cooking, washing dishes, vacuuming, cleaning sinks, etc.) Explain

    

9.    Have you ever helped anyone take their own medications? Explain


10.    Are you familiar with understanding the importance of following nutrition guidelines for individuals?  


11.    Are you familiar with diabetes, blood pressure, renal failure, etc? Explain


12.    Are you familiar with multiple diagnosis individuals, both medically and mentally?

    

13.    Have you ever helped anyone feed themselves?


14.    Are you familiar with Seizure protocol and how to recognize the grades of seizures? Explain

    

15.    Have you ever had to handle an aggressive episode?  What did you do?  What would you do differently if you had it to do all over again?

    

16.    Do you have reliable transportation?

    

17.    Do you speak Spanish? 

    

18.    Do you know sign language?

    

19.    What kind of hobbies have you enjoyed in the past?


20.    Do you understand the stress that comes along with DCS on field trips and outings?  And how to handle?

    

21.    What job would you ultimately like to have in five or ten years from now?


22.    Are you able to Volunteer for 1 field trip per month?


23.    Are you comfortable supervising our TEAM members in their job programs?


24.    Are you familiar with the community aspect of our program and the importance of helping those we serve remain active in that community?



PERSONAL    

Last Name                                                    First                                      Initial    

Social Security #


Other Name(s) Used    

Home Telephone #

(       )


Date of Birth    

EMAIL:


Address


Position Applied For    

Referred By    

Salary Desired



Have you ever interviewed with the Company or its affiliates before?    • Yes• No    

If yes, list date(s), job title(s) & location(s)


Have you ever been employed by the Company or its affiliates before?    • Yes• No    

If yes, list date(s), job title(s) & location(s)


Do you have any relatives employed by the Company or its affiliates?       • Yes• No    

If yes, list date(s), job title(s) & location(s)


Are you at least 18 years old?

• Yes• No    

If under 18, do you have a work permit?


EDUCATION    

Circle Highest Grade Completed:    High School    9    10    11    12

College, Trade or Business    1    2    3    4

Graduate Studies                


School    

Address    

Major Studies    

Degree, Diploma,

License or Certificate

Year Graduated


High School

    

    



College/University

    

        



Vocational, Business, Other

    

    

    


List Any Professional Designations



Other Special Knowledge, Skills or Qualifications




For Clerical Applicants Only:


Do you type?    • Yes    • No        If yes, WPM:



Computer Skills (Hardware/Software)




EMPLOYMENT HISTORY


List all employments for the past 10 years, starting with the most recent position. All information must be completed. You may attach a resume, but not in place of completing the required information.


Employed From

/    /    

Employer Name    

Supervisor Name    

Starting Salary


Employed Until

/    /    

Employer Address    

Supervisor Phone #    

Ending Salary


Job Title

    

Reason for Leaving


Duties & Responsibilities


Employed From

/    /    

Employer Name    

Supervisor Name    

Starting Salary


Employed Until

/    /    

Employer Address    

Supervisor Phone #    

Ending Salary


Job Title

    

Reason for Leaving


Duties & Responsibilities



Employed From

/    /    

Employer Name    

Supervisor Name    

Starting Salary


Employed Until

/    /    

Employer Address    

Supervisor Phone #    

Ending Salary


Job Title

    

Reason for Leaving


Duties & Responsibilities



REFERENCES

Below, give the names of three persons you are not related to, whom you have known at least one year.

NAME                ADDRESS & PHONE NUMBER                 BUSINESS              YEARS

                                                    ACQUAINTED

1

2

3



SERVICE RECORD

BRANCH OF                                 DISCHARGE DATE

SERVICE                                RANK




DRIVING HISTORY

Have you ever had a moving violation ticket?              YES    NO

IF YES, EXPLAIN, PLEASE PROVIDE APPROXIMATE DATES:



CRIMINAL HISTORY

TEAM Abilities, Inc. will request a criminal conviction check per the Department of Health and Human Services.  Convictions Barring Employment are listed on the attached affidavit.  Felony and Misdemeanor Convictions automatically deny employment.

HAVE YOU BEEN ARRESTED OR CONVICTED OF A FELONY OR A MISDEMEANOR?                YES    NO

If Yes, Please explain: 





GENERAL

 

Yes    No    May we contact your current employer for references?

Yes    No    If hired, will you be able to work overtime?

Yes    No    Will you be able to perform the essential job functions for the position you are applying

for with or without reasonable accommodation?



CERTIFICATION & AUTHORIZATION

 

The above information is true and correct.   I understand that, in the event of my employment by the Company, I shall be subject to dismissal if any information that I have given in this application is false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery.


I authorize the Company to inquire into my educational, professional, and past employment history references as needed to research my qualifications for this position.  I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information.  I further authorize the Company to obtain any credit any consumer check.


I understand that nothing in this employment application, the granting of an interview or my subsequent employment with the Company is intended to create an employment contract between myself and the Company under which my employment could be terminated only for cause.  On the contrary I understand and agree that, if hired, my employment will be terminable at will and may be terminated by me or the Company at any time and for any reason.  I understand that no persona has any authority to enter into any agreement contrary to the foregoing.


If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986.  The document(s) provided will be used for completion of Form I-9.  


I hereby acknowledge that I have read and agree to the above statements.



___________________________________            ___________________________________  Employee’s  Signature     Date 



AFFIDAVIT

This agency may employ a person pending receipt of results of a criminal history check in an emergency situation.  The Department of Human Services and the Department of Health has defined an emergency as the urgent need to employ an individual as a result of a survey deficiency on staffing ratios and/or the potential of the facility to fall below their desired staff ratio, thus putting the consumer’s health or safety at risk.


I, ____________________________________ have been informed that this agency will request a criminal conviction check on myself per the Department of Health and Human Services.  I, _________________________________ am signing this Affidavit for this agency, stating that I have not been convicted of a barring offense.


§ 250.006.  Convictions Barring Employment (a) A person for whom the facility is entitled to obtain criminal history record information may not be employed in a facility if the person has been convicted of an offense listed in this subsection:

Bars Pursuant to Health and Safety Code §250.006

Texas Penal Code

•    Chapter 19 — Criminal homicide:  includes Murder, Capital Murder, Manslaughter, or Criminally negligent homicide

•    Chapter 20 — Kidnapping and unlawful restraint 

•    §21.02 — Continuous sexual abuse of young child or children

•    §21.08 — Indecent Exposure

•    §21.11 — Indecency with a child

•    §21.12 — Improper relationship between educator and student

•    §21.15 — Improper photography or visual recording

•    §22.01 — Assault: Class A Misdemeanor or Felony conviction, which occurred within the previous five years.

•    §22.011 — Assault, Sexual

•    §22.02 — Assault, Aggravated

•    §22.021 — Assault, Aggravated Sexual

•    §22.04 — Injury to a child, elderly individual, or disabled individual

•    §22.041 — Abandoning or endangering a child

•    §22.05 — Deadly Conduct

•    §22.07 — Terroristic Threat

•    §22.08 — Aiding suicide

•    §25.031 — Agreement to abduct from custody

•    §25.08 — Sale or purchase of a child

•    §28.02 — Arson

•    §29.02 — Robbery

•    §29.03 — Robbery, Aggravated

•    §30.02 — Burglary: a conviction which occurred within the previous five years.

•    Chapter 31 — Theft: a conviction that is punishable as a felony which occurred within the previous five years. 

•    §32.45 — Misapplication of fiduciary property or property of a financial institution: a Class A Misdemeanor or Felony conviction which occurred in the previous five years.

•    §32.46 — Securing execution of a document by deception: a Class A Misdemeanor or Felony conviction which occurred in the previous five years.

•    §33.021 — Online solicitation of a minor

•    §34.02 — Money laundering

•    §35A.02 — Medicaid fraud

•    §36.06 — Obstruction or Retaliation

•    §37.12 — False identification as a peace officer: a conviction which occurred in the previous five years.

•    §42.01(a)(7),(8), or(9) — Disorderly conduct associated with the discharge or display of a firearm in a public place: a conviction which occurred in the previous five years.

•    §42.09 — Cruelty to animals

•    §42.092 — Cruelty to nonlivestock animals

•    A conviction under the laws of another state, federal law, or the Uniform Code of Military Justice for an offense containing elements that are substantially similar to the elements of an offense listed above. 

Additional to Bars to Employment

Bars pursuant to Texas Administrative Code, Title 40, Part 1, Chapter 3, §3.201 Texas Health and Safety Code 

•    Chapter 481 — Texas Controlled Substances Act:  a conviction that is punishable as a felony (involving manufacture, delivery, intent to distribute, conspiracy to posses or produce with intent to distribute, distribution to a minor, illegal expenditure or investment, or transfer or receipt of chemical laboratory apparatus). 

Texas Penal Code

•    §15.01 — Criminal Attempt of any offense listed as a bar

•    §43.03 — Promotion of Prostitution

•    §43.04 — Aggravated Promotion of Prostitution

•    §43.05 — Compelling Prostitution

•    §43.25 — Sexual Performance by a Child

•    §43.26 — Possession or Promotion of Child Pornography 

Or potentially barring offense(s) which would represent a contraindication to employment to work in contact with consumers.  I, ______________________________ understand that this Affidavit will be maintained in the facilities personnel records a minimum of 60 days waiting period has expired.  


I, _________________________________________ understand that if a conviction is returned by the Texas Department of Public Safety, immediate termination will result.  I will be allowed to appeal this decision if I so choose in accordance with this agency’s Grievances Procedures.



SIGNED:    ____________________________    DATE:  _______________________


WITNESS: ____________________________    DATE:  _______________________

DRUG AND/OR ALCOHOL TESTING CONSENT FORM

 

EMPLOYEE AGREEMENT AND CONSENT TODRUG AND/OR ALCOHOL TESTING

 

I hereby agree, upon a request made under the drug/alcohol testing policy of TEAM Abilities, 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 the Company 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 a Company 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                




__________________________  ___________


Print Name of Employee                Date



__________________________  ___________        

Executive Administrator               Date                
agraph here.

To book an immediate appointment, call Anna Lamb at 832-895-8010. 

AVAILABLE! 2500 SQ FT OF AFFORDABLE EVENT RENTAL SPACE!       

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