Employment

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Thank you for choosing Nix Private Care for your next career move.
 
Employment Application
Various laws prohibit discrimination based on race, color, sex, religion, national origin, age, or disability. We are an equal opportunity employer and your response to any question will not be used as a basis for discrimination but will be judged on its relevance to the position you are seeking.
       
Fields marked with * are required.
Your Contact Information
* First Name:
* Last Name:
* Address:
* City: * State:
* Zip:
* Phone:
E-mail:
 
Contact information for Person to notify in case of EMERGENCY
* First Name:
* Last Name:
 Address:
City: State:
Zip:
* Phone:
 
Application Information
When can you start:
 
How did you come in contact with Nix Private Care:
 
* Are you under 18 years of age?:
  Yes   No     If Yes, state your age:
You must be able to provide proof of age or an employment certification.
 
Education
Education 1:
Type of School:
Name of School:
Address:
Did You Graduate: Yes   No
Degree Received:
Education 2:
Type of School:
Name of School:
Address:
Did You Graduate: Yes   No
Degree Received:
Education 3:
Type of School:
Name of School:
Address:
Did You Graduate: Yes   No
Degree Received:
 
Work Authorization
* Are you legally authorized to work in the U.S.?:
  Yes   No
(Before Employment, you will be required to provide proof of work authorization to work and remain permanently in the United States.)
 
Employment History
* May we contact your present employer?
  Yes   No
* May we contact your prior employer?
  Yes   No
(Present or last employer first.)
Employer 1:
Employer's Name:
Employer's Phone:
Employer's Address:
Employed From:
(mm/dd/yyyy)		 Employed To:
(mm/dd/yyyy)
Start Salary:
 Final Salary:
Name and Title of Supervisor:
Position Title:
Reason for Leaving:
Employer 2:
Employer's Name:
Employer's Phone:
Employer's Address:
Employed From:
(mm/dd/yyyy)		 Employed To:
(mm/dd/yyyy)
Start Salary:
 Final Salary:
Name and Title of Supervisor:
Position Title:
Reason for Leaving:
Employer 3:
Employer's Name:
Employer's Phone:
Employer's Address:
Employed From:
(mm/dd/yyyy)		 Employed To:
(mm/dd/yyyy)
Start Salary:
 Final Salary:
Name and Title of Supervisor:
Position Title:
Reason for Leaving:
 
Previous Employment Information
* Were you ever discharged by any company?
  Yes   No
  If Yes, give name of company:
  Reason for discharge:
If you are now employed, why do you want to make the change?
 
If you have been unemployed at any time since leaving school, please explain.
 
 
Criminal History
* Have you, in the past five years, either received deferred adjudication for, or been convicted of a felony?
  Yes   No
  If Yes, please explain and give details:
A conviction record will not necessarily be a bar to employment. Factors such as age at time of offense, the date, seriousness and nature of the offense, and rehabilitation will be taken into consideration.
 
Resume Upload
Please attach your resume, if available.
You may upload only one file.
  Click here to upload your resume...
 
Please read carefully before submitting your application

I HEREBY CERTIFY THAT THE ANSWERS BY ME TO THE ABOVE QUESTIONS AND STATEMENTS ARE TRUE AND CORRECT, AND THAT NO ATTEMPT HAS BEEN MADE BY ME TO CONCEAL PERTINENT INFORMATION. I UNDERSTAND THAT ANY OMISSION OR MISSTATEMENT OF FACTS MAY RESULT IN A DECISION NOT TO EMPLOY ME OR IF DISCOVERED AFTER EMPLOYMENT, MY IMMEDIATE DISCHARGE. I FURTHER UNDERSTAND THAT IF I AM EMPLOYED, SUCH EMPLOYMENT RELATIONSHIP WILL BE "AT WILL," FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR NOTICE.

I read and accepted the statement.   
* Check this box to certify that you have read and accept the above statement.

       
 
 

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5000 Broadway   San Antonio, Texas 78209   210.341.9122   210.344.3675 fax
5900 Balcones Dr., Suite 215   Austin, Texas 78731   512.322.9555   512.322.2499 fax
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