Application for Employment Concho Valley CSCD Employment Application If you need assistance in completing the employment application, please inquire at the Human Resources Office. The Concho Valley CSCD/CCF conducts pre-employment qualification testing and personal interviews in the application process. If you believe you will require reasonable accommodation (e.g., interpreter, TDD, scheduling adjustments) for pre-employment testing or a personal interview, you must notify the Human Resources Office at least 24 hours prior to the scheduled test or interview. HUMAN RESOURCES OFFICE PHONE: 325-659-6544 FAX 325-658-6346 3036 N. Bryant Blvd. San Angelo, Texas 76903Position Applying For* Last Name* First Name* Middle Initial* Email* Enter Email Confirm Email Social Security Number* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Available Contact Phones Home Phone Mobile Phone Work Phone Home Phone Mobile Phone Work Phone Which type(s) of work will you accept?* Full-Time Part-Time Temporary Which shifts will you work?* Day Shift Evening Shift Night Shift Which days of the week are you NOT willing to work?* Sun Mon Tue Wed Thu Fri Sat I'm willing to work any day. Have you filed an application here before?* Yes No Date MM slash DD slash YYYY Have you ever been employed here before?* Yes No Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Have you ever been employed by Tom Green County before?* Yes No Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Are you or your spouse related to any officer/employee of Concho Valley CSCD/CCF ?* Yes No Do you have a High School Diploma or GED Certificate?* Yes No Please enter all known information. You can add up to 4 more schools/institutions.Please enter all known information. You can add up to 4 more schools/institutions.Schools Attended and LocationDates Attended (MM/YY-MM/YY)Semester Hrs CompletedGrade AverageMajor FieldDegree Received If currently employed, may we contact your supervisor?* Yes No Number of Previous (or Current) EmployersChoose the number of previous (or current) employers you would like to provide history for.01234Most Recent Employer LocationAddressCityStateZipPhoneFrom MM slash DD slash YYYY To MM slash DD slash YYYY Summary of Job DutiesReason for leaving? Starting Salary Ending Salary Salary Period Annual Monthly Weekly Hourly Previous Job Type Contract Full-Time Paid Internship Part-Time Permanent Temporary Unpaid Internship Previous Employer #2 LocationAddressCityStateZipPhoneFrom MM slash DD slash YYYY To MM slash DD slash YYYY Summary of Job DutiesReason for leaving? Starting Salary Ending Salary Salary Period Annual Monthly Weekly Hourly Previous Job Type Contract Full-Time Paid Internship Part-Time Permanent Temporary Unpaid Internship Previous Employer #3 LocationAddressCityStateZipPhoneFrom MM slash DD slash YYYY To MM slash DD slash YYYY Summary of Job DutiesReason for leaving? Starting Salary Ending Salary Salary Period Annual Monthly Weekly Hourly Previous Job Type Contract Full-Time Paid Internship Part-Time Permanent Temporary Unpaid Internship Previous Employer #4 LocationAddressCityStateZipPhoneFrom MM slash DD slash YYYY To MM slash DD slash YYYY Summary of Job DutiesReason for leaving? Starting Salary Ending Salary Salary Period Annual Monthly Weekly Hourly Previous Job Type Contract Full-Time Paid Internship Part-Time Permanent Temporary Unpaid Internship Licenses & CertificationsLicense/CertificationDate Obtained (MM/YY)Description of Particular SkillsetExpiration (MM/YY) Additional Training/Skills/QualificationsSummarize any additional training or skills that may qualify you as being able to perform job - related functions in the position for which you are applying.Resume UploadIf you have a resume in MS Word or PDF format, you can upload it, here.Accepted file types: doc, docx, pdf, Max. file size: 64 MB.Work Authorization*By law, you must be authorized to work in the United States, in order to be employed by Concho Valley CSCD/CCF. Authorization requires that you are one of the following: • A citizen or a national of the United States. • An alien lawfully admitted for permanent residence. • An Alien authorized by the Immigration and Naturalization Service to work indefinitely in the United States. I am authorized to work in the United States Have you ever been convicted of a felony or subjected to a deferred adjudication on a felony charge?*If "Yes", please explain below. (You may omit convictions for minor traffic violations, unless the position for which you are applying requires the operation of a motor vehicle. Conviction will not result in your automatic disqualification for employment. The seriousness of the crime, the date of conviction, and the relevance of the crime to this position will be considered. Yes No ExplanationIf the position for which you are applying requires the operation of a motor vehicle, do you have a current Texas Driver's License? Yes No Texas DL#: CDL? Yes No Endorsements Do you speak a language other than English (if required for this position)? Yes No If "Yes", which language(s) do you speak? Have you ever served in the United States military?* Yes No Describe any job-related training received in the United States military.Have you ever been discharged from the United States Armed Forces under other than honorable conditions? Yes No References*List three persons not related to you who are qualified to describe your capabilities for the position you seek.NameAddressPhoneOccupation NOTE TO APPLICANTS: A complete written description of the "essential" functions or activities involved in the job you are applying for is posted in the Human Resources Office and on our web page. If you have been informed about the requirements and essential functions of the job you are applying for, answer the question below.Are you capable of performing the "essential" functions or activities involved in the job for which you have applied?* Yes No Applicant's Statement*I certify that the statements and information contained herein are true, complete, and correct to the best of my knowledge, and I authorize any former employer to release to this employer or its authorized representative any and all employment records and other information it may have about my employment. I understand that the information will be used for the purpose of evaluating my application for employment and that I am responsible for providing legal documents verifying my identity and eligibility for employment. In addition, I understand that, if selected for an interview, true copies of all degrees, certificates, or licenses listed on this application will be required before an employment decision can be made. A photocopy of this authorization shall be as valid as the original. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time, and that intentional misrepresentation on my application or during the interview process will subject me to immediate discharge. I also understand that only written representations and promises of this employer will be enforceable. (Sign with mouse, stylus or finger) Reset signature Signature locked. Reset to sign again Acknowledgement by Applicant*If you are hired and your Concho Valley CSCD/CCF job requires you to operate a Department vehicle, you are hereby advised that you may be terminated if you become uninsurable by the Department insurance provider standards due to excessive traffic violations, irrespective of fault, during the course of employment. (Sign with mouse, stylus or finger) Reset signature Signature locked. Reset to sign again PREA Standards § 115.217 Requires the following questions about misconduct:(1) Have you engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility, or other institution (as defined in 42 U.S.C. § 1997)?* Yes No (2) Have you been convicted of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse?* Yes No (3) Have you been civilly or administratively adjudicated to have engaged in the activity described in question (2)?* Yes No Form SecurityCommentsThis field is for validation purposes and should be left unchanged. Menu LinksCJAD Tom Green county District Courts Texas CSCD Directory
