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PERSONAL:

EMPLOYMENT DESIRED:

EDUCATION:

(Name, Address and Location)
(Name, Address and Location)

MILITARY:

WORK HISTORY:

List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references.

DO NOT REFERENCE YOUR RESUME.


DO NOT REFERENCE YOUR RESUME.


DO NOT REFERENCE YOUR RESUME.

SUPPLEMENTAL EMPLOYMENT INFORMATION:

REFERENCES:

(Give three references, not relatives or former employers.)



AFFIDAVIT:

I certify that my answers to the foregoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge.

I hereby authorize Cheyenne Center, Inc. to contact any company or individual it deems appropriate to investigate my employment history, character and qualifications and I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. I also understand that my employment is “at-will” and may be terminated by myself or by the company at any time for any reason or no reason at all, with or without prior notice.

Type your name

24/7 Helpline
1-800-662-4357

Residential Treatment Facility
10525 Eastex Freeway
Houston, Texas 77093
Tel: 713-691-4898
Fax: 713-691-0024

Outpatient Treatment Facility
2620 E. Crosstimbers Street
Houston, Texas 77093
Tel: 832-230-5435
Fax: 832-201-8850

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© 2020 Cheyenne Center, Inc.