TX DL:*
SSN:*
NAME AND ADDRESS
Last Name:*
First Name:*
Middle Name:
Present Address:*
City, State, Zip:*
Previous Address:*
City, State, Zip:*
Home Phone:
Work Phone:
Cell Phone: *
E-mail Address:*
POSITION INFORMATION
Schedule Desired: (select all that apply)*
Full-Time Part-Time Temporary Day Evening Weekend Summer
Available To Start:*
Salary Required:*
Hours Available:*
Days Available:*
Are you legally authorized to work in the U.S.?*
YES NO
Have you applied to DSS, Inc. Before?*
YES NO
If yes, when?
How were you referred to DSS, Inc.?
Agency Job Fair Newspaper School Walk-in Internet By a current DSS, Inc. employee
If employee, who?
I was previously a DSS, Inc. employee (Dates / / - / /)
EDUCATION
High School diploma or equivalent required for employment.
High School:*
City / State:*
Last Grade Completed and GPA (x.x):*
College:
City / State:
Major Field of Study:
Dates Attended ( / - / ), GPA (x.x):
Degree:
Graduate School:
City / State:
Major Field of Study:
Dates Attended ( / - / ), GPA (x.x):
Degree:
Other Certificate:
City / State:
Major Field of Study:
Dates Attended ( / - / ), GPA (x.x):
Certificate:
SPECIAL SKILLS
(Provide information only if it is related to the position sought)
Office Skills
Typing
WPM:
10 Key by touch
KPM:
Data Entry
WPM:
Other
Software
Word Processing
Length of Experience:
Spreadsheets
Length of Experience:
Desktop Publishing
Length of Experience:
Other Software
Software & Length of Experience:
What languages do you speak other than English?
PROFESSIONAL REFERENCES
For reference purposes: Have you ever used another name?
YES NO
If YES, please state name and dates:
Reference Name:
Business Phone:
Home Phone:
How do you know this person?
Reference Name:
Business Phone:
Home Phone:
How do you know this person?
Reference Name:
Business Phone:
Home Phone:
How do you know this person?
EMPLOYMENT HISTORY
Please provide the following information for each of your last 4 employers or last 10 years of employment history. You may attach your resume below, but this form must also be completed in its entirety.
Current Employer (if applicable):
Address:
Position:
Hire Date:
Supervisor:
Phone:
Hourly Rate:
or Salary Rate:
Reason For Leaving:
Termination Date:
May we contact your present employer?
YES NO
If NO, when may we contact?
Previous Employer:
Address, City, State, Zip:
Phone:
Position:
Hire Date:
Termination Date:
Rate of Pay:
Supervisor’s Name:
Reason For Leaving:
Previous Employer:
Address, City, State, Zip:
Phone:
Position:
Hire Date:
Termination Date:
Rate of Pay:
Supervisor’s Name:
Reason For Leaving:
Previous Employer:
Address, City, State, Zip:
Phone:
Position:
Hire Date:
Termination Date:
Rate of Pay:
Supervisor’s Name:
Reason For Leaving:
PERIODS OF UNEMPLOYMENT
(Four-weeks Or Longer)
Beginning Date From:
Ending Date To:
Explanation:
Beginning Date From:
Ending Date To:
Explanation:
Beginning Date From:
Ending Date To:
Explanation:
Why you want to work for DSS, Inc.
Please write a short paragraph stating why you want to work for this company. You may also use this space to describe other skills and aptitudes that you feel qualify you for a position with our organization. You may list security and/or fire equipment with which you have experience.
Important Authorizations And Agreements:
I authorize DSS, Inc. to verify the accuracy of the information contained on this application and to make inquiries regarding my employment and/or education for the purpose of determining my suitability for a position with DSS, Inc.. I understand that the social security number I have provided is subject to verification.
In the event of my employment I will furnish proof of my eligibility to work in the United States within three days of starting work. I may also be asked to furnish proof of educational attainment.
Nothing in this application or in any handbook, policy, procedure, or work rule of DSS, Inc. shall constitute a contract of employment, express or implied. The employment relationship is at will and may be terminated by the employee or DSS, Inc. at any time, with or without cause.
I hereby authorize all persons, educational institutions, and employers named in this application to provide DSS, Inc. with any relevant information that may be required to arrive at any employment decision.
I certify that all statements I have made in this application are true and agree that any misrepresentation or omissions of facts called for may be sufficient cause for terminating consideration of my application for employment, or immediate dismissal from DSS, Inc.’s service, if I have been employed.
Authorizations and Agreements --- I Agree*
By checking this box, you agree to the Authorizations and Agreements
Past Personal Conduct:
Please list below all activities or conduct on your part (other than traffic violations) to which you have entered a plea of guilty, no contest, nolo contendere or any plea other than not guilty. Also include any activity or conduct that resulted in your being found guilty, placed on probation, or given deferred ajudication. Give the date you were placed on probation, location, the name of the court and nature of each activity or conduct.
Past Personal Conduct --- I Agree*
By checking this box, you are verifying your statement above
CONSENT AND ACKNOWLEDGEMENTS
Pre-employment Testing Notice:
As part of the company’s pre-employment selection process, you may be asked to complete a battery of tests. The skills that our tests evaluate are related to essential job functions and are required by business necessity. These tests are normally presented in written format and completed within a specified time limit. Satisfactory completion of this testing may be a pre-requisite for employment with the company. If you require an alternative format due to disability, please advise prior to the testing
Testing Notice --- I Agree*
Checking this box is acknowledging that you have read and agreed to this notice.
Drug Screen Consent:
By checking the box below, I hereby authorize the company to conduct, through its designated physician & laboratory testing facility, a drug test that will require a urine sample. I acknowledge that this test is a condition of employment. I consent to the release of the test results from the laboratory to management personnel at the company.
I also understand that the drug test is performed to determine the presence of certain controlled substances. I also understand that all employees of the company are subject to random drug testing and hereby consent to the release of the results of any such test for which I may be selected during my employment with the company.
I further understand that if I refuse to consent to such testing, or if I consent and the performed test is positive, the company will no longer consider my application for employment. I expressly release this company, its parent, subsidiaries, affiliates, directors, officers, agents and employees from liability arising from any conduct, other than negligence, related to any drug testing to which I have consented.
I understand that I will be asked to submit the test under certain time requirements. The location will be specified and paid for by the company. I understand that I must have a government issued photo ID to be shown to the testing laboratory before any test can be administered.
Drug Screen Consent --- I Agree*
Checking this box is a consent to Drug Screening
The company is licensed by the Texas Department Of Public Safety and/or the Texas State Fire Marshal’s Office.
The following documentation is required in order to process your application:
Texas Driver’s License Social Security Card
*Copies of these documents will be made and affixed to this application.
If you are currently licensed by the Texas Department of Public Safety and/or the Texas State Fire Marshal’s Office, a copy of that license(s) should be uploaded.
Upload Documents
Upload Texas Driver’s License:
Upload Social Security Card:
Other License or Document Upload:
