EMPLOYMENT APPLICATION
Please complete the entire application.
1. Employer Information
Employer:
Address:
City/State/ZIP:
Telephone:
A Better Bail Bond and A Better Insurance Group
10024 Homestead Street
Houston, Texas 77016
713-635-8400
It is the policy of A Better Bail Bond and A Better Insurance Group to provide equal employment
opportunities to all applicants and employees without regard to any legally protected status such
as race, color, religion, gender, national origin, age, disability or veteran status.
2. Applicant Information
Applicant Full Name:
Home Address:
City/State/ZIP:
Number of years at this address: _
Daytime phone: Evening phone:
Mobile phone:
Social Security Number:
Driver's License (State/Number):
3. Emergency Contact
Who should be contacted if you are involved in an emergency?
Contact Name:
Relationship to you:
Address:
City/State/ZIP:
Daytime phone Evening phone:
4. Job Position Applied For:
Full or Part Time?
5. Salary Desired $ ____________ per ____________
6. Who referred you to our company? _____________________________________
Do you have any friends or relatives who work here? If yes, please list here:
___________________________________________________________
7. Have you applied to our company previously?______ Yes ______ No
If yes, when? ________________________
8. Are you at least 18 years old?______ Yes ______ No
9. Are you willing to work any shift, including nights and weekends? _____ Yes _____ No
If no, please state any limitations:
________________________________________________
10. If applicable, are you available to work overtime? _____ Yes _____ No
11. If you are offered employment, when would you be available to begin work?
____________________________________
12. If hired, are you able to submit proof that you are legally eligible for
employment in the United States? _____ Yes _____ No
13. Are you able to perform the essential functions of the job position you seek with
or without reasonable accommodation?______ Yes ______ No
What reasonable accommodation, if any, would you request?
________________________________________________
14. Have you ever been convicted of a felony or misdemeanor?
______ Yes, I was convicted of ______________________________ on ____________
(date) in _________________ (city), _______________ (state)
______ No
THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC
BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.
15. Applicant's Skills
Check those skills that you have. List any other skills that may be useful for the job you are
seeking. Enter the number of years of experience, and circle the number which corresponds to
your ability for each particular skill. (One represents poor ability, while five represents
exceptional ability.)
Ability or Skill Years of Experience and Rating
[ ] Typing__________________1 2 3 4 5
[ ] Microsoft Office Suite (Word, Excel, etc.)__________________ 1 2 3 4 5
[ ] Accounting/Bookkeeping__________________1 2 3 4 5
[ ] Answering Telephones__________________ 1 2 3 4 5
[ ] Filing__________________1 2 3 4 5
[ ] Customer Service__________________1 2 3 4 5
[ ] Management __________________1 2 3 4 5
[ ] Problem Solving __________________1 2 3 4 5
[ ] Runner __________________1 2 3 4 5
______________________________________________1 2 3 4 5
______________________________________________1 2 3 4 5
16. Applicant Employment History
List your current or most recent employment first. Please list all jobs (including self-employment
and military service) which you have held, beginning with the most recent, and list and explain
any gaps in employment. If additional space is needed, continue on the back page of this
application.
Employer Name:
Supervisor Name:
Address:
City/State/ZIP:
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):
Employer Name:
Supervisor Name:
Address:
City/State/ZIP:
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):
Employer Name:
Supervisor Name:
Address:
City/State/ZIP:
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):
17. Applicant's Education and Training
College/University Name and Address
____________________________________________________________
Did you receive a degree?______ Yes _____ No
If yes, degree(s) received: ___________
High School/GED Name and Address
____________________________________________________________
Did you receive a degree?______ Yes _____ No
Other Training (graduate, technical, vocational):
____________________________________________________________
Please indicate any current professional licenses or certifications that you hold:
____________________________________________________________
Awards, Honors, Special Achievements:
____________________________________________________________
Military Service:
______ Yes _____ No
Branch:
Specialized Training:
18. References
List any two non-relatives who would be willing to provide a reference for you.
Name:
Address:
City/State/ZIP:
Telephone:
Relationship:
Name:
Address:
City/State/ZIP:
Telephone:
Relationship:
19. Please provide any other information that you believe should be considered, including
whether you are bound by any agreement with any current employer:
CERTIFICATION
I certify that the information provided on this application is truthful and accurate. I understand
that providing false or misleading information will be the basis for rejection of my application, or
if employment commences, immediate termination.
I authorize A Better Bail Bond and A Better Insurance Group to contact former employers and
educational organizations regarding my employment and education. I authorize my former
employers and educational organizations to fully and freely communicate information regarding
my previous employment, attendance, and grades. I authorize those persons designated as
references to fully and freely communicate information regarding my previous employment and
education.
I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND
AGREE TO ITS TERMS.
____________________________________
APPLICANT SIGNATURE
_______________
DATE
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