Fillable 242 - Employment Application

Fill Online, Printable, Fillable, Blank 242 - Employment Application Form

Use Fill to complete blank online CITY OF BROWNWOOD (TX) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

242 - Employment Application

On average this form takes 80 minutes to complete

The 242 - Employment Application form is 20 pages long and contains:

  • 4 signatures
  • 18 check-boxes
  • 295 other fields

Country of origin: US
File type: PDF

U.S.A. forms for CITY OF BROWNWOOD

BROWSE CITY OF BROWNWOOD (TX) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
TO ALL JOB APPLICANTS:
1. ALL INFORMATION ON THE EMPLOYMENT APPLICATION MUST BE COMPLETE AND
ACCURATE.
2. SUBMITTING YOUR APPLICATION WITH FALSE INFORMATION WILL BE REASON FOR
DISQUALIFICATION.
3. INTERVIEWS ARE BY APPOINTMENT ONLY. CITY STAFF WILL CONTACT THE APPLICANTS
SELECTED FOR AN INTERVIEW. CALLING TO CHECK THE STATUS OF YOUR APPLICATION
IS NOT NECESSARY AND MAY DELAY THE PROCESS
.
4. SELECTION AND PLACEMENT IN A POSITION WITH THE CITY OF BROWNWOOD IS
CONTINGENT UPON SUCCESSFUL COMPLETION OF DRUG SCREENING WITH NEGATIVE
RESULTS
.
5. ATTACH A COPY OF YOUR HIGH SCHOOL DIPLOMA, GED CERTIFICATE, OR COLLEGE
TRANSCRIPT IF REQUIRED FOR THE POSITION(S) YOU ARE AP
PLYING FOR.
6. PERSONS EMPLOYED IN A POSITION REQUIRING A DRIVER LICENSE WILL BE REQUIRED
TO HAVE A CURRENT DRIVER LICENSE PRIOR TO APPOINTMENT.
7. AFTER COMPLETING THIS APPLICATION, PLEASE RETURN IT TO THE HUMAN RESOURCES
DEPARTMENT AT CITY HALL, LOCATED AT 501 CENTER AVENUE, OR MAIL TO P.O. BOX
1389, BROWNWOOD, TX 76804, OR FAX TO HUMAN RESOURCES CONFIDENTIAL FAX
(325) 643-3749, OR E-MAIL TO HRpersonnel@brownwoodtexas.gov
.
If you have any questions, feel free to call the City of Brownwood
Human Resources Department at (325) 646-5775.
Thank you for considering the City of Brownwood for a place of employment.
Equal Opportunity Employer.
David Dalleh
Director of Human Resources & Civil Service
P.O. Box 1389
BROWNWOOD, TEXAS 76804
325-646-5775
FAX: 325-643-3749
www.brownwoodtexas.gov
HRpersonnel@brownwoodtexas.gov
1
(Use Ink Only)
CITY OF BROWNWOOD
EMPLOYMENT APPLICATION
FOR OFFICE USE ONLY:
Current TX Driver’s License Yes No
HS Diploma/GED Yes No
HS Diploma/GED Attached Yes No
HS/College Transcript Attached Yes No
DD214 Form Attached Yes No NA
DPS/CCH Form Yes No
NAME
(PRINT)
(Last) (First) (Middle)
Last
four
digits
of
your
Social
Security
Number:
You may apply for Posted Positions
ONLY
(When completing your application form, indicate which position you are applying
for.)
PLEASE, DO NOT PUT “ANY” or “OPEN”
.
POSITION(S) APPLYING FOR:
(Job Title) (Dept. Name) (Job Number)
(Job Title) (Dept. Name) (Job Number)
(Job Title) (Dept. Name) (Job Number)
In completing and signing this application for employment, I understand that misrepresentation or omission of facts is
cause for cancellation of this application or separation from the City’s service if I am employed. I agree that the City
shall not be liable in any respect if my employment is terminated because of the falsity of statements, answers or
omissions made by me on this application.
In connection with my application for employment, or if I am offered employment, at any time during my
employment, the City may conduct an investigation of me as part of the process of considering my candidacy as an
employee or as deemed necessary during my employment. I understand that the investigative report may include
among other things, information as to my character, general reputation, criminal history, personal characteristics,
and previous employment history. This information may be obtained by contacting, among others, my previous
employers or references supplied by me. I hereby release from all liability or damages the City of Brownwood and
those individuals, corporations, or organizations, who provide such information. I understand any such information
provided shall become the exclusive property of the City of Brownwood.
All employees of the City of Brownwood are employees at will and, as such, are free to resign at any time. The
City of Brownwood also retains the right to terminate any employee’s employment at any time.
This application is current for only thirty days. At the conclusion of this time, if I have not heard from the City of
Brownwood and still wish to be considered for employment, it will be necessary for me to fill out a new
application.
How did you hear about the position?
City Employee Newspaper
Brownwood
Business Website School City Hall
City of Brownwood Website Facebook LinkedIn Other _____________________________
Signature
Date
click to sign
signature
click to edit
2
PRESENT ADDRESS:
No. & Street
City
State
Zip
Telephone
Number
Email
Address
PREVIOUS ADDRESS: During the last ten years beginning with most recent. If you lived out of state, please
provide full address including zip code.
1) No. & Street
City
State
Zip
2) No. & Street
City
State
Zip
3) No. & Street
City
State
Zip
ADDITIONAL INFORMATION:
Would you accept night work? Yes No
Are you now employed? Yes No May we contact your present employer? Yes No
Are you legally eligible to work in the United States? Yes No
Amount
of
notice
required
before
starting
work?
Do you have relative(s) employed with the City of Brownwood? Yes No
Name
Relationship
to
you?
Have you ever been employed by the City of Brownwood? Yes No
When
Position
Supervisor
Have you ever had a conviction, deferred adjudication, or placement on probation for a felony or crime other than
traffic violations? Yes No
If yes, please explain. (Disclosure of a criminal record does not automatically disqualify you for employment.
Consideration of your case will be judged on its own merit)
The City of
Brownwood’s
drug testing program provides for testing under the following conditions:
Pre-employment, post-accident, post-injury, reasonable suspicion, and post-rehabilitation monitoring.
Random drug tests are conducted on DOT and safety-sensitive positions.
Are you using or have you used illegal drugs in the past three (3) years?
Yes
No
Have you tested positive or refused to test on any
pre-employment
drug or alcohol test
administrated
by any
employer during the past three (3) years:
If yes, please explain:
Yes No
PERSON TO CONTACT IN CASE OF AN EMERGENCY:
Name
Relationship
Address
City
State
Telephone Number(s): Home ___________________ Work ___________________ Cell ___________________
EMPLOYMENT HISTORY:
Beginning with the most recent, list below jobs held now and in the past. Also list any other experience related to the
position for which you are applying. Include military and volunteer work. PLEASE GIVE VALID CONTACT
NUMBERS ON INFORMATION FOR EACH EMPLOYER. THIS SECTION MUST BE FILLED OUT
COMPLETELY EVEN IF ATTACHING A RESUMÉ.
Name of Company:
Supervisor Name:
Company Address:
Supervisor Title:
Supervisor Phone:
Type of Business:
To (Mo./Yr.):
Position Held:
Ending Salary:
Description of Work (include skills and equipment operated):
Reason for Leaving:
Name of Company:
Supervisor Name:
Company Address:
Supervisor Title:
Supervisor Phone:
Type of Business:
To (Mo./Yr.):
Position Held:
Ending Salary:
Description of Work (include skills and equipment operated):
Reason for Leaving:
Name of Company:
Supervisor Name:
Company Address:
Supervisor Title:
Supervisor Phone:
Type of Business:
To (Mo./Yr.):
Position Held:
Ending Salary:
Description of Work (include skills and equipment operated):
Reason for Leaving:
Name of Company:
Supervisor Name:
Company Address:
Supervisor Title:
Supervisor Phone:
Type of Business:
To (Mo./Yr.):
Position Held:
Ending Salary:
Description of Work (include skills and equipment operated):
Reason for Leaving:
3
4
LIST ALL DRIVER LICENSES EVER HELD: (THIS SECTION MUST BE COMPLETED BY
ALL APPLICANTS)
STATE
OPERATOR’S LICENSE
CLASS
C
COMMERCIAL LICENSE
CLASS A or
B
RESTRICTIONS
LICENSE
NUMBER
EXPIRATION
DATE
LICENSE
NUMBER
EXPIRATION
DATE
DRIVING EXPERIENCE: (Completion of this section is required if you are applying for a position
that involves driving a City vehicle.)
How
many
years
have
you
been
driving?
Employer’s
vehicle
Passenger
Car
How
many
years
have
you
driven
commercially?
Can
you
drive
a
clutch
operated
transmission
vehicle?
Do
you
have
a
current
driver’s
license?
If
yes,
type:
Class
A
Class
B
Class
C
List
CDL
endorsements
Has
any
license
you
ever
held
been:
Suspended?
Revoked?
When?
For
how
long?
Why?
In
what
state(s)?
Have
you
any
other
driving
experience?
What
size
vehicle?
Length
of
time
and
type
of
vehicle
driven.
ACCIDENT RECORD: (Completion of this section is required if you are applying for a position
that involves driving a City vehicle.)
How many
accidents
have you ever been
involved
in,
regardless
of severity?
How
many
as
an
operator
of:
Commercial
vehicles?
Private
cars?
DATE
CITY AND STATE
BRIEF
DESCRIPTION
OF ACCIDENT
Last Accident
Next Previous
Next Previous
Next Previous
5
TRAFFIC VIOLATIONS: (Completion of this section is required only if you are applying for a
position that involves driving a City vehicle.)
List all violations, other than parking, for which you have been convicted.
DATE
OF
VIOLATION
TYPE
OF
VIOLATION
NAME &
LOCATION
OF
COURT
DATE
OF
CONVICTION
DISPOSITION
AND
FINE
EDUCATION: (THIS SECTION MUST BE COMPLETED BY ALL APPLICANTS)
NAME OF SCHOOL
CITY-STATE
COURSE
OF
STUDY
GRAD.
YES/NO
HIGH SCHOOL
COLLEGE
COLLEGE
TECHNICAL, BUSINESS
OR
OTHER
If no High School diploma, do you have a G.E.D.? Yes
No
(Attach a copy of your high school diploma or G.E.D. or college transcript.)
Are
you
presently
attending
school?
If
yes,
time
of
day?
Are you a veteran of the military service? If yes, please attach a copy of DD Form 214.
FOR OFFICE POSITION ONLY:
OFFICE EXPERIENCE: Indicate your specific skills and experience.
TYPE OF EXPERIENCE
YRS.
TYPE OF
EXPERIENCE
YRS.
TYPE OF
EXPERIENCE
YRS.
Accounts
Payable
Data Entry
Multi Line
Phone System
Accounts
Receivable
Payroll
Other:
Billing
Receptionist
Other:
Collections
Secretarial
Other:
SKILLS: Indicate below office skills and office machines you can operate.
Personal Computer: Yes No Type(s) of Computer
Types
of
Software:
Calculator (by touch): Yes No Other office machines:
6
Please list all skills that you feel would qualify you for
employment
with the City.
PERSONAL
REFERENCES:
(MUST LIST AT LEAST 3 THAT ARE NOT RELATIVES)
NAME
ADDRESS
HOME PHONE
WORK PHONE
I hereby certify that this application was completed by me, and that all entries on it and information in it are true
and complete to the best of my knowledge.
Date Applicant’s Signature
click to sign
signature
click to edit
9
This page left
blank
intentionally.
DPS Computerized Criminal History (CCH) Verification
(AGENCY COPY)
I, , acknowledge that a Computerized Criminal
APPLICANT or EMPLOYEE NAME (Please print)
History (CCH) check may be performed by accessing the Texas Department of Public Safety Secure
Website and may be based on name and DOB identifiers. (This is not a consent form, but serves as
information for the applicant.) Authority for this agency to access an individual’s criminal history data
may be found in Texas Government Code 411; Subchapter F.
Name-based information is not an exact search and only fingerprint record searches represent
true identification to criminal history record information (CHRI), therefore the organization conducting
the criminal history check is not allowed to discuss with me any CHRI obtained using the name and
DOB method. The agency may request that I also have a fingerprint search performed to clear any
misidentification based on the result of the name and DOB search.
In order to complete the fingerprint process I must make an appointment with the Fingerprint
Applicant Services of Texas (FAST) as instructed online at www.txdps.state.tx.us /Crime
Records/Review of Personal Criminal History or by calling the DPS Program Vendor at 1-888-467-2080,
submit a full and complete set of fingerprints, request a copy be sent to the agency listed below, and pay
a fee of $25.00 to the fingerprinting services company.
Once this process is completed the information on my fingerprint criminal history record may be
discussed with me.
(This copy must remain on file by this agency. Required for future DPS Audits)
___________________________________
Signature of Applicant or Employee (optional)
Date
Agency Name (Please print)
Agency Representative Name (Please print)
___________________________________
Signature of Agency Representative
Date
Rev. 09/2015
Please:
Check and Initial each Applicable Space
CCH Report Printed:
YES
NO
initial
Purpose of CCH:
Empl
Vol/Contractor
initial
Date Printed:
/
initial
Destroyed Date:
initial
Retain in your files
City of Brownwood
Pre-Employment
click to sign
signature
click to edit
9
This page left
blank
intentionally.
February 2019
AUTHORIZATION
I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by City of
Brownwood (“Company”) and its consumer reporting agency Sarma. If hired (or contracted), this authorization
shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time
during, as permitted by law, my employment, contract, or volunteer period. I authorize without reservation, any
person, business or agency contacted by the consumer reporting agency to furnish the above-mentioned
information.
In connection with my application for employment, I direct the following regarding my current employer:
(please check one). Yes, my current employer may be contacted ________ / No, my current employer cannot
be contacted _________
I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the Summary
of Rights _____________ (initials).
I authorize Company and Agency to use email communication with me to provide me with notices and
information regarding any report or use of such report. If I do not have an email address or do not wish to share
it, then communication will be by U.S. Mail, which will result in slower communication.
If you have any questions concerning this background screening content, please contact: Sarma at 555 East
Ramsey, San Antonio, TX 78216, or at (800) 955-5238.
Printed Full Name: _________________________________________________________________________
Signature: ________________________________________________________________________________
Date: _________________________
Email: _________________________________; I do not have or want email __________________________
(Initial)
If “no”, list mailing address:__________________________________________________________________
For identification purposes:
Social Security No.: ___________________________; Date of Birth: _____________________________
Driver’s License No.: __________________________; State of Issue: _____________________________
Other Names Used: _________________________________________________________________________
_________________________________________________________________________________________
9
This page left
blank
intentionally.
10
EEO Voluntary Self-Identification Form
Name
Date
of
Application
Last First Middle
Other
Names
Used-(including
maiden
names
and
all
marriage
names)
Date
of
Birth
Male
Female
Social
Security
Number
-
-
Notice - Completion of this form is voluntary.
We are an Equal Opportunity Employer. Our employment decisions are made without regard to race, color, religion,
gender, national origin, age, disability, marital status, veteran or military status, or any other legally protected status.
The purpose of this EEO Self-Identification Form is to comply with federal government record-keeping and reporting
requirements. Periodic reports are made to the government on the following information. The data you provide on this
form will be kept confidential and used solely for analytical and reporting requirement purposes. This form is
processed and maintained separately from your personnel file and is not used to make decisions about the terms and
conditions of employment. Completion of this form is optional and voluntary. We appreciate your assistance.
HIGHEST LEVEL OF EDUCATION COMPLETED:
1. 0-8 years
2. 9-12 years, but not a high school graduate
3. High School Graduate
4. GED Certificate
5. Post high school, vocation or business
6. Some college, less than B.A.
7. B.A., B.S., or similar degree
8. M.A., M.S., or similar degree
9. PhD., or similar degree
10. M.D., or similar professional degree
ETHNIC CATEGORY (Check one)
_____ White: a person having origins in any of the people of Europe, the Middle East, or North Africa.
_____ Black or African American: a person having origins in any of the black racial groups of Africa.
_____ Hispanic or Latino: a person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or
other Spanish culture or origin, regardless of race.
_____ Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam.
_____ Native Hawaiian or Other Pacific Islander: a person having origins of any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific Islands.
_____ American Indian or Alaska Native: a person having origins in any of the original peoples of North and
South America (including Central America), and who maintains tribal affiliation or community attachment.
_____ Two or More Races: a person who primarily identifies with two or more of the above race/ethnicity categories.
_____ I do not wish to voluntarily supply this information.
(continued on back)
Put a checkmark next to the appropriate level.
11
EEO Voluntary Self-Identification Form (continued)
Notice - Completion of this form is voluntary.
VETERAN STATUS (Check all that apply)
_____ Disabled Veteran: A veteran who served on Active Duty in the U.S. military and is entitled to disability
compensation (or who but for the receipt of military retired pay would be entitled to disability compensation) under
laws administered by the Secretary of Veteran’s Affairs, or was discharged or released from active duty because of a
service-connected disability.
_____ Active duty wartime or campaign badge Veteran: a veteran who served on active duty in the U.S. military
during a war or in a campaign or expedition for which a campaign badge has been authorized under the laws
administered by the Department of Defense.
_____ Armed Forces Service Medal Veteran: a veteran who served on active duty in the U.S. military and participated
in a United States military operation for which an Armed Forces Service Medal was awarded.
_____ Recently Separated Veteran: a veteran during the three-year period beginning on the date of such veteran’s
discharge or release from active duty in the U.S. military.
_____ I am a veteran, but I chose not to self-identify the classifications to which I belong.
_____ I am NOT a veteran.
_____ I do not wish to voluntarily supply this information.
VOLUNTARY SELF-IDENTIFICATION
Are you able to perform the essential function of the job(s) you are seeking, with or without accommodations?
_____ Yes _____ No
_____ I do not wish to voluntarily supply this information.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

242 - Employment Application

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 11 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document