Fillable Application for Employment (Texas Tech University)

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Application for Employment (Texas Tech University)

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The Application for Employment (Texas Tech University) form is 5 pages long and contains:

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  • 23 check-boxes
  • 141 other fields

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File type: PDF

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Application for Employment
TTU Human Resources Application for Employment Page 1 of 5
Texas Government Code Section 657.007, states an employment preference may be extended to qualified veterans, surviving spouses and orphans in the event
there are two or more individuals equally qualified for a position. It must be given at the time of final selection. To claim veteran's preference, verifying
documentation must be submitted to the employment office.
Texas Government Code Section 672.001, states an employment preference must be extended to an applicant that is 25 years of age or under and was under the
permanent managing conservatorship of the DFPS as a foster child on the day preceding their 18th birthday. Such preference is to be granted over other applicants
who do not have a greater qualification. To claim preference, verifying documentation must be submitted to the employment office.
It is the policy of Texas Tech that in all aspects of its operations each person shall be considered solely on the basis of qualifications, without regard to race, color,
sex, religion, national origin, age, disabilities or Vietnam-era veteran status, refusal to submit to a genetic test, or any other legally protected class. With few
exceptions, you have the right to request and be informed about the information that Texas Tech collects about you. You are entitled to receive and review that
information upon request. You also have the right to ask Texas Tech to correct any information that is determined to be false.
For instructions to submit documentation, contact: Texas Tech University, (806) 742-3851 ext.238, email: hrs.employee.services@ttu.edu
Date of Application
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
From To From To From To From To From To From To From To
AM
PM
Days and Hours Available for Work:
Position Applying for
When will you be able to begin work?
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Referral Source
Employee Relative Walk-In Private Employment Agency
Government Employment Agency Other
First Name
Personal Information
Middle Name Last Name
Address
City
Zip Code
Home Phone Work Phone Cell/Other Phone
Country
Email (If you do not have an e-mail address, please sign up for any free internet e-mail account)
Yes No
Can you submit verification of your legal rights to work in the United States? (Proof of eligibility will be
required upon employment)
State
TTU Human Resources Application for Employment Page 2 of 5
Education
Name of School Type of School
City
Course of Study Last month and year attended
Yes No
Did you graduate / complete program?
If you did not graduate / complete the program, number of credit hours completed
Degree / Certificate
State
Name of School Type of School
City
Course of Study Last month and year attended
Yes No
Did you graduate / complete program?
If you did not graduate / complete the program, number of credit hours completed
Degree / Certificate
State
Yes No
Are you 17 years of age or under?
Yes No
Have you ever been employed at any Texas Tech component
Yes No
Are you related by blood or marriage to any member of the Board of Regents of Texas Tech?
Yes No
Are you related by blood or marriage to any employee of Texas Tech?
Yes No
Have you ever been convicted, placed on probation, or placed on deferred adjudication for any criminal
charges?
Select Highest Educational Level
If yes, relative's name and department
If yes, provide details (Type of Offense/ Date / Sentence / Deposition)
Work Experience
Zip Code
City
Address
Phone Number
Begin Date End Date (Leave blank if Current Job)
Work Performed
State
Employer Name
TTU Human Resources Application for Employment Page 3 of 5
Zip Code
City
Address
Phone Number
Begin Date End Date (Leave blank if Current Job)
Work Performed
Ending Salary Supervisor Name Supervisor Title
Reason for Leaving Type of Work May we contact this employer?
State
Employer Name
Zip Code
City
Address
Phone Number
Begin Date End Date (Leave blank if Current Job)
Work Performed
Ending Salary Supervisor Name Supervisor Title
Reason for Leaving Type of Work May we contact this employer?
State
Employer Name
Ending Salary Supervisor Name Supervisor Title
Reason for Leaving Type of Work May we contact this employer?
List professional, trade, business, or civic associations and any offices held. (Exclude memberships which would reveal sex, race,
religion, national origin, age, color, disability or other protected status.)
List special accomplishments, publications, awards. (Exclude memberships which would reveal sex, race, religion, national origin,
age, color, disability or other protected status.)
Skills and Qualifications
Summarize special skills and qualifications acquired from employment or other experience that may qualify you to work for Texas
Tech
TTU Human Resources Application for Employment Page 4 of 5
Certify
I certify that all answers to the questions in my application and the supplemental questions and the information contained in my resume and other attached
documents, if any, are true, complete, and correct to the best of my knowledge. I further understand that any misstatement, falsification, or omission of information
will be sufficient grounds for rejection of the application, or termination of employment.
I authorize Texas Tech to make reference checks relating to my employment and I also authorize all prior employers to provide full details concerning my past
employment. I release all such parties from all liabilities from any damages which may result from furnishing such information. I understand that this application and
all attachments are the property of Texas Tech.
I understand that any offer of employment tendered me is contingent upon my agreement to abide by the rules and regulations of Texas Tech.
I understand that if I am applying for any position involved in patient care or the process of billing of medical services, my name must not be found on the Texas
Department of Health State / Federal Medicare and Medicaid exclusion lists. Any offer of my employment will be void if my name is found on the exclusion listing.
I understand that if I am male, I am required to sign a Certification of Registration Status for the Selective Services as a requirement for employment. I further
understand that if I am a male age 18 through 25, I must show proof of registration with Selective Services at the time of hire.
I understand that any offer of employment is contingent upon my completing the Immigration and Naturalization Service Employment Eligibility Verification (Form
I-9) and providing documents to verify my identity and employment eligibility as required by law. When completing the Form I-9, I will be required to attest that I
am a citizen or national of the U.S., a lawful Permanent Resident or an alien authorized to work.
I understand that if I am assigned to work on a federal contract at any Texas Tech entity that contains a clause requiring the contractor to use the E-Verify program,
that my eligibility for employment will be confirmed through the E-Verify system.
If I am applying for employment at Texas Tech University, I understand that if I am applying for a security sensitive position, I will be subject to a background
investigation and/or drug test.
I understand that continuation of employment is at the discretion and will of the institution. This is an application for employment and no employment contract is
being offered. If employed, such employment is for an indefinite period of time and the institution can change wages, benefits and conditions or may terminate the
employee at any time.
I certify that I have read and agree with these statements.
Signed By Signature
Date
List any additional information you would like us to consider.
Personal References (List name and telephone number of three business/work references who are not related to you and who are
not your previous supervisors. If not applicable, list three school or personal references who are not related to you.)
Name Telephone Years Known
TTU Human Resources Application for Employment Page 5 of 5
As required, we comply with government regulations including Affirmative Action obligations where they apply.
In an effort to comply with requirements regarding government record keeping, reporting and other legal obligations, we ask that
you complete this applicant data survey. Your Cooperation is appreciated. Please be advised that your survey is not a part of your
official application for employment. It is considered confidential information that will not be used in any hiring decision.
Date Position Applied For
Middle NameLast Name First Name
Social Security Number
Sex
Ethnicity
AI, American Indian / Alaskan Native AS, Asian B, Black
CU, Cuban American HP, Native Hawaiian/Pacific IslanderHI, Hispanic
PR, Puerto Rican living in USNR, Non-Resident AlienMX, Mexican American
WH, WhiteU, Unknown
Special Notice to Vietnam Era Veterans, Disabled veterans and individuals with physical or mental handicaps or disabilities.
Government contractors subject to the Vietnam Era Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to
take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and
qualified handicapped individuals. You are invited to volunteer this information, if you qualify, to assist in proper placement and
determining reasonable accommodation. This information will not adversely affect your consideration for employment.
If you wish to be identified, please check if any of the following are applicable.
Not Selected Other Protected Veteran Only Vietnam Veteran Only
Both Vietnam / Other Protected Veteran Individual w/ a disability
To be completed by applicant - Not for interview purposes - To be filed separately from application.
This information is used to satisfy the Affirmative Action requirements of Section 503 of the Rehabilitation Act or necessitated by
another federal law or regulation.
Voluntary Affirmative Action Form
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Application for Employment (Texas Tech University)

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Completed 16 August 2021

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