Revised October 30, 2019
Last Name First Middle
City, State, Zip
Have you ever applied for employment with us?
Yes No If yes: Month and Year Location
Social Security #
Position Desired Texas Drivers License #
Are you available for full-time work?
Yes No If not, what hours can you work?
Are you legally eligible for employment in the United States? Yes No
(Proof of citizenship or immigration will be required upon employment)
When will you be available to
If employed and you are under 18, can you furnish a work permit? Yes
No Will you work overtime if asked?
Other special training or skills (electrical, mechanical , clerical or technical, etc.)
Can you work weekends when
scheduled or re
Have you ever been convicted, plead guilty or no contest, or received deferred adjudication before: Yes No
If yes, give date and detail of each conviction. (A conviction record is not an automatic ban to employment. The nature of the crime will be
considered in relation to the position for which you are applying)
st any prev
ous or current re
at you may
Did you serve in th
U.S. Armed Forces?
If Yes, what branch
Type discharge received
(a less than honorable discharge is not an automatic ban to employment. The circumstances of
the discharge will be considered in relation to the position for which you are applying)
Describe any training received relevant to the position for which you are applying.
Prospective employees will receive consideration without discrimination
because of race, creed, color, sex, age, national origin, disability, or veteran status.
City of Harker Heights WebVLWH
Please tell us how you heard about this position.