Application for Employment

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 76903

Position Applying For*

Last Name*

First Name*

Middle Initial*

Email*

Enter Email Confirm Email

Social Security Number*

Address*

Street Address City 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

Have you ever been employed here before?*

Yes
No

Start Date

End Date

Have you ever been employed by Tom Green County before?*

Yes
No

Start Date

End Date

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.

Schools Attended and Location	Dates Attended (MM/YY-MM/YY)	Semester Hrs Completed	Grade Average	Major Field	Degree Received

If currently employed, may we contact your supervisor?*

Yes
No

Number of Previous (or Current) Employers

Choose the number of previous (or current) employers you would like to provide history for.

Most Recent Employer

Location

Address	City	State	Zip	Phone

From

To

Summary of Job Duties

Reason for leaving?

Starting Salary

Ending Salary

Salary Period

Annual
Monthly
Weekly
Hourly

Previous Job Type

Previous Employer #2

Location

Address	City	State	Zip	Phone

From

To

Summary of Job Duties

Reason for leaving?

Starting Salary

Ending Salary

Salary Period

Annual
Monthly
Weekly
Hourly

Previous Job Type

Previous Employer #3

Location

Address	City	State	Zip	Phone

From

To

Summary of Job Duties

Reason for leaving?

Starting Salary

Ending Salary

Salary Period

Annual
Monthly
Weekly
Hourly

Previous Job Type

Previous Employer #4

Location

Address	City	State	Zip	Phone

From

To

Summary of Job Duties

Reason for leaving?

Starting Salary

Ending Salary

Salary Period

Annual
Monthly
Weekly
Hourly

Previous Job Type

Licenses & Certifications

License/Certification	Date Obtained (MM/YY)	Description of Particular Skillset	Expiration (MM/YY)

Additional Training/Skills/Qualifications

Summarize 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 Upload

If you have a resume in MS Word or PDF format, you can upload it, here.

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

Explanation

If 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.

Name	Address	Phone	Occupation

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)

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)

Form Security

Name

This field is for validation purposes and should be left unchanged.

Concho Valley CSCD Employment Application

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