Fillable City of Tomball Employment Application 401 Market Street, (City of Tomball)

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City of Tomball Employment Application 401 Market Street, (City of Tomball)

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  • 104 check-boxes
  • 171 other fields

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Page 1 of 8
City of Tomball
Employment Application
401 Market Street, Tomball, TX 77375
281-290-1087 phone; 281-290-1088 fax
hr@tomballtx.gov www.tomballtx.gov
The City of Tomball only accepts applications/resumes for open, currently posted, authorized job openings. Applicants must
complete all the blanks accurately and completely to be considered. All information provided is subject to verification. A FALSE
STATEMENT OR OMISSION MAY RESULT IN DISQUALIFICATION FOR EMPLOYMENT OR DISCHARGE, IF EMPLOYED. The City of
Tomball is an Equal Opportunity Employer and prohibits discrimination in employment because of race, color, sex, religion,
national origin, age, disability and any other protected status under the State or Federal guidelines. No question on this
application is intended to secure information to be used for discriminatory purposes.
POSITION APPLIED FOR:
DATE:
(mm/dd/yy)
DATE YOU WOULD BE ELIGIBLE TO WORK:
CHECK ALL TYP
ES OF WORK YOU WILL ACCEPT
FULL-TIME
PART-TIME
TEMPORARY
DAYS
EVENINGS
WEEKENDS
NIGHTS
ARE YOU ABLE TO MEET THE SCHEDULE AND ATTENDANCE
REQUIREMENTS OF THE POSITION FOR WHICH YOU ARE APPLYING?
YES
NO
WILL YOU WORK
MORE THAN 40 HOURS IN A WEEK IF REQUIRED?
YES
NO
PERSONAL INFORMATION Please Print in Ink or Type
NAME:
(LAST, FIRST, MIDDLE)
SOCIAL SECURITY NO.:
RESIDENCE ADDRESS:
APT. NO.
STATE:
ZIP:
CELL PHONE:
ALTERNATE MEANS OF CONTACT:
ARE YOU AUTHORIZED TO WORK LAWFULLY IN THE UNITED STATES?
Y
N
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to
complete the required employment eligibility form upon hire.
HAVE YOU EVER USED ANOTHER NAME(S)?
Y If yes, please specify:
N
DRIVERS LICENSE NUMBER:
STATE ISSUED:
CLASS A
CLASS B
CLASS C
EXPIRATION DATE:
DO YOU HAVE A COMMERCIAL
DRIVER’S LICENSE?
Yes
No
IF YES, CHECK CLASS
CLASS A
CLAS
S B
CLASS C
ENDORSEMENT:
T
P
N
H
X
Page 2 of 8
Have you ever served in the
armed services?
Yes
No
Branch of Service:
Type of Discharge:
Dates of Service:
Have you ever been employed by the
City of Tomball?
Yes
No
If yes, dates of employment:
Department:
Reason for Leaving:
Are you related to any member of the City Council or
any person employed by the City of Tomball?
Yes If yes, Name:
No
Department:
Relationship:
CRIMINAL HISTORY Prior to employment, applicants will be investigated as to convictions for prior criminal offenses. Answering
"yes" may not automatically disqualify you, but a false statement or omission of information will. A prior conviction will be
considered in relationship to the requirements of the job for which you are applying. Failure to answer th
e questions below
truthfully may result in immediate dismissal.
Have you ever pled guilty or no contest, been convicted, placed on deferred adjudication or community supervision to a felony or
misdemeanor offense in a civilian or military court in the past ten years?
If yes, list all such offenses and disposition date, name of
court/state, charge and result. You may omit minor violations for which you paid a fine of $50 or less and/or parking violations.
Yes
No
DISPOSITION DATE:
COURT/ STATE
CHARGE:
RESULT:
DISPOSITION DATE:
COURT/ STATE
CHARGE:
RESULT:
DISPOSITION DATE:
COURT/ STATE
CHARGE:
RESULT:
DISPOSITION DATE:
COURT/ STATE
CHARGE:
RESULT:
Is your driver’s license presently restricted, suspended or revoked:
Yes If yes, give reason:
No
If yes, give date it began and date it will end:
Start Date:
End Date:
EDUCATION
Have you earned a High School
Diploma or GED?
Yes
No
If no, last grade
completed:
High School, City and State
What is your highest level of education?
____Some High School ____Bachelor’ s Degree
____High School ____Master’s Degree
____Technical College ____Doctorate Degree
____Associate’s Degree
Additional Information:
Page 3 of 8
COLLEGE, BUSINESS, TECHNICAL SCHOOLS ATTENDED- EDUCATION MAY CONTINUED ON ADDITIONAL SHEETS
SCHOOL NAME:
TECHNICAL COLLEGE
COLLEGE
GRADUATE SCHOOL
CITY:
STATE:
COUNTRY:
MAJOR/MINOR:
DEGREE:
START DATE:
END DATE:
DID YOU GRADUATE?
YES
NO IF NO, # HRS. COMPLETED:
SCHOOL NAME:
TECHNICAL COLLEGE
COLLEGE
GRADUATE SCHOOL
CITY:
STATE:
COUNTRY:
MAJOR/MINOR:
DEGREE:
START DATE:
END DATE:
DID YOU GRADUATE?
YES
NO IF NO, # HRS. COMPLETED:
SCHOOL NAME:
TECHNICAL COLLEGE
COLLEGE
GRADUATE SCHOOL
CITY:
STATE:
COUNTRY:
MAJOR/MINOR:
DEGREE:
START DATE:
END DATE:
DID YOU GRADUATE?
YES
NO IF NO, # HRS. COMPLETED:
SPECIAL QUALIFICATIONS AND SKILLS
LANGUAGES OTHER THAN ENGLISH:
SPEAK
READ
WRITE
LANGUAGES OTHER THAN ENGLISH:
SPEAK
READ
WRITE
List qualifications and skills you possess which are required for the job described in the official job
announcement and machines or office equipment you can use, such as computer equipment, types of
software and hardware, etc. Indicate any training you have had which is directly related to the job.
Page 4 of 8
EMPLOYMENT H
ISTORY
Start with your present or most recent position. List ALL work experience for the past 10 years, plus any additional related experience, as well as any City and
military experience. Be as specific as possible when listing your job duties. Attach additional sheet(s) if necessary. A RESUME MAY BE ATTACHED BUT WILL NOT BE
SUBSTITUTED FOR A COMPLETED APPLICATION. Please list one job position per space. ALL INFORMATION IS SUBJECT TO VERIFICATION. YOU MUST INCLUDE
TELEPHONE NUMBERS.
CURRENTLY EMPLOYED? Y___ or N___ MAY WE CONTACT? Y___ or N___ ELIGIBLE FOR REHIRE? Y___ or N___
PRESENT EMPLOYER: ___________________________________________________________________________________
ADDRESS: _______________________________________________ CITY/STATE: ________________________________
POSITION TITLE: ________________________________________ ___ FULL TIME ___ PART TIME ___VOLUNTEER
START DATE: _____________ END DATE: _____________ ENDING SALARY: ________________________________
SUPERVISOR’S NAME/TITLE: ___________________________________________ PHONE: ________________________
REASON FOR LEAVING:
DESCRIBE DUTIES YOU PERFORMED & ACQUIRED FOR THE POSITION FOR WHICH YOU ARE APPLYING:
EMPLOYER: _________________________________________________________ ELIGIBLE FOR REHIRE? Y____ or N____
ADDRESS: _______________________________________________ CITY/STATE: ________________________________
POSITION TITLE: ________________________________________ ___ FULL TIME ___ PART TIME ___VOLUNTEER
START DATE: _____________ END DATE: _____________ ENDING SALARY: ________________________________
SUPERVISOR’S NAME/TITLE: ___________________________________________ PHONE: ________________________
REASON FOR LEAVING:
DESCRIBE DUTIES YOU PERFORMED & ACQUIRED FOR THE POSITION FOR WHICH YOU ARE APPLYING:
EMPLOYER: _________________________________________________________ ELIGIBLE FOR REHIRE? Y____ or N____
ADDRESS: _______________________________________________ CITY/STATE: ________________________________
POSITION TITLE: ________________________________________ ___ FULL TIME ___ PART TIME ___VOLUNTEER
START DATE: _____________ END DATE: _____________ ENDING SALARY: ________________________________
SUPERVISOR’S NAME/TITLE: ___________________________________________ PHONE: ________________________
REASON FOR LEAVING:
DESCRIBE DUTIES YOU PERFORMED & ACQUIRED FOR THE POSITION FOR WHICH YOU ARE APPLYING:
Page 5 of 8
EMPLOYER: _________________________________________________________ ELIGIBLE FOR REHIRE? Y____ or N____
ADDRESS: _______________________________________________ CITY/STATE: ________________________________
POSITION TITLE: ________________________________________ ___ FULL TIME ___ PART TIME ___VOLUNTEER
START DATE: _____________ END DATE: _____________ ENDING SALARY: ________________________________
SUPERVISOR’S NAME/TITLE: ___________________________________________ PHONE: ________________________
REASON FOR LEAVING:
DESCRIBE DUTIES YOU PERFORMED & ACQUIRED FOR THE POSITION FOR WHICH YOU ARE APPLYING:
EMPLOYER: _________________________________________________________ ELIGIBLE FOR REHIRE? Y____ or N____
ADDRESS: _______________________________________________ CITY/STATE: ________________________________
POSITION TITLE: ________________________________________ ___ FULL TIME ___ PART TIME ___VOLUNTEER
START DATE: _____________ END DATE: _____________ ENDING SALARY: ________________________________
SUPERVISOR’S NAME/TITLE: ___________________________________________ PHONE: ________________________
REASON FOR LEAVING:
DESCRIBE DUTIES YOU PERFORMED & ACQUIRED FOR THE POSITION FOR WHICH YOU ARE APPLYING:
IF YOU HAVE INDICATED IN THE EMPLOYMENT HISTORY SECTION THAT YOU HAD A GAP IN EMPLOYMENT, WERE YOU LAID OFF
OR DISMISSED FROM A POSITION? Y____ or N____
If YES, PLEASE EXPLAIN:
HAVE YOU EVER BEEN DISMISSED AND/OR ALLOWED TO RESIGN IN LIEU OF DISCHARGE? Y ____ or N ____
IF YES, EXPLAIN:
WORK REL
ATED REFERENCES List three references other than relatives, whom you have known for at least one year.
NAME: ________________________________________________ RELATIONSHIP: ______________________________
PHONE: _______________________
ADDRESS, CITY, STATE, ZIP CODE: ______________________________________________________________________
YEARS KNOWN: _________
NAME: ________________________________________________ RELATIONSHIP: ______________________________
PHONE: _______________________
ADDRESS, CITY, STATE, ZIP CODE: ______________________________________________________________________
YEARS KNOWN: _________
NAME: ________________________________________________ RELATIONSHIP: ______________________________
PHONE: _______________________
ADDRESS, CITY, STATE, ZIP CODE: ______________________________________________________________________
YEARS KNOWN: _________
Page 6 of 8
PLEASE READ CAREFULLY AND SIGN BELOW
I certify that my answers are true and complete to the best of my knowledge and that I have made no misrepresentation in this
application and attachment(s), and I have not withheld information in my statements and answers to questions. I understand
that any misstatement, falsification, or omission of information shall be grounds for the rejection of my application, refusal to
hire, or if hired, termination.
I understand that the City of Tomball will require me to successfully complete a pre-employment drug test and a background
check as a condition of employment and that continued employment may be based on the successful completion of similar tests.
Depending on the nature of the position I am seeking, I understand the City of Tomball may conduct post-offer pre-employment
testing including but not limited to, medical, physical, psychological, polygraph and agility test to assess my qualifications for a
particular position. If I require accommodation when the City administers pre-employment tests, I will notify Human Resources in
writing of any accommodations when I submit my application.
I authorize any of the persons, organizations, and educational institutions referenced in this Employment Application to give
officials of the City of Tomball any and all information concerning my previous employment, education, motor vehicle record,
criminal background information, credit reports, or any other information they might have, personal or otherwise, with regard to
any of the subjects covered by this application. I release unconditionally and irrevocably such parties from all liability from any
damages which may result from furnishing such information to the City of Tomball.
I hereby authorize the City of Tomball to investigate and verify any representations made by me, either orally or in writing. I
hereby release the City of Tomball and any individual who provides or obtains information pursuant to this authorization, from
any and all liability for damages of any kind which may result to me on the account of compliance, or attempts to comply, with
this authorization.
I understand that if I am hired, it will be at the discretion of the Department Director, subject to the approval of the City Manager,
as prescribed in the City Charter. I understand that city employment is "at will" which means that the city has no obligation to
continue to employ me in the future. I understand that city employees are subject to the City of Tomball's personnel policies and
administrative policies, as amended. Copies of these policies are available in the Human Resources Department.
I understand that my application is subject to the Texas Open Records law and may be released as a public document. I also
understand that this application is the property of the City of Tomball and will become a part of my personnel file if I am hired. I
further understand that this is an application for employment and that no employment is being offered and that the City of
Tomball, in receiving this application, has made no contract of employment with me and has not in any way guaranteed my
future employment.
FULL NAME PRINTED: _________________________________________________________
SIGNATURE OF APPLICANT: ___________________________________________________DATE: _______________________
REVISION 07/01/2018
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signature
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Page 7 of 8
TO BE COMPLETED BY APPLICANT:
The information requested below is being collected in order to comply with federal reporting requirements and WILL
NOT BE CONSIDERED as part of the application for employment. It will be separated from the application. It will not
be used for hiring, placement, or any other decision relating to terms and conditions of employment. If hired, it will
not become part of your personnel file. Completion of this form is voluntary and failure to complete will not affect
your application status.
The City of Tomball is an Equal Opportunity Employer. The city does not discriminate on the basis of race, color,
religion, sex, age, national origin, disability or veteran status.
PLEASE PRINT
NAME:
(LAST, FIRST, MIDDLE)
SOCIAL SECURITY NO.:
POSITION APPLIED FOR:
SEX:
FEMALE
MALE
DATE OF BIRTH:
ETHNIC ORIGIN (CHECK ONE):
ASIAN/PACIFIC ISLANDER
BLACK
HISPANIC
AMERICAN INDIAN/ALASKAN NATIVE
WHITE (NOT OF HISPANIC ORIGIN)
HOW DID YOU FIND OUT ABOUT THIS JOB?:
ADVERTISEMENT IN :___________________________
CITY EMPLOYEE
INTERNET
FAMILY OR FRIEND
CITY WEBSITE
OTHER:_____________________________________
SIGNATURE OF APPLICANT: ___________________________________________________DATE: ___________________________
CITY OF TOMBALL
HUMAN RESOURCES DEPARTMENT
VOLUNTARY APPLICANT INFORMATION FORM – EEO DATA
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signature
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Page 8 of 8
DPS Computerized Criminal History (CCH) Verification
(Agency Copy)
I, _________________________________________________have been notified that a Computerized Criminal
APPLICANT (Please print)
History (CCH) verification check will be performed by accessing the Texas Department of Public Safety Secure
Website and will be based on name and DOB identifiers I supply.
Because the name-based information is not an exact search and only fingerprint record searches represent
true identification to criminal history, the organization conducting the criminal history check for background
screening is not allowed to discuss any criminal history record information obtained using the name and DOB
method. Therefore, depending on the position in which I am applying for, the agency may request that I have
a fingerprint search performed to clear any misidentification based on the result of the name and DOB search.
For the fingerprinting process I will be required to submit a full and complete set of my fingerprints for
analysis through the Texas Department of Public Safety AFIS (Automated Fingerprint Identification System). I
will be given information to complete the fingerprint process, if applicable.
Once this process is completed and the agency receives the data from DPS, the information on my fingerprint
criminal history record may be discussed with me.
(T
his copy must remain on file by your agency. Required for future DPS Audits)
For HR Use Only
Signature of
Applicant______________________________________
Da
te_______________________________
Ag
ency Name___________________________________
Ag
ency
Representative__________________________________
Si
gnature of Agency Rep.__________________________
Da
te_________________________________
CCH Report Printed:
Yes
No initial____________
Pur
pose of CCH:______________________________
Hired
Not Hired initial____________
Da
te Printed:_______________ initial_____________
Da
te Destroyed_____________ initial_____________
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City of Tomball Employment Application 401 Market Street, (City of Tomball)

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Completed 5 August 2020

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