State application
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The applicant is applying for a position with the State of Texas. The application requests standard employment information such as name, contact details, education history, employment history, military service, and availability. It notes that the State of Texas is an equal opportunity employer and does not discriminate. The applicant must sign to confirm the accuracy of the information provided and authorize references to be contacted.
State application
- 1. THE STATE OF TEXAS APPLICATION FOR EMPLOYMENT For State Agency Use Only g Date received __________ Time received __________ Received by ___________ PRINT IN BLACK INK OR TYPE. These instructions must be followed exactly. Fill out application form completely. If questions are not applicable, enter "NA." Do not leave questions blank. Be sure to sign when completed. The State of Texas is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services. You may make copies of this application and enter different position titles, but each copy must be signed. Resumes will not be accepted in lieu of applications, unless specifically stated in the job vacancy notice. This application becomes public record and is subject to disclosure. With few exceptions, you have the right to request and be informed about information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. (Reference: Government Code, Sections 552.021, 552.023 and 559.004.) NAME (Last) (First) E-MAIL ADDRESS (City) (Daytime Phone) (State) (Zip) ( ) (Country) (Work Phone, Optional) List exact title of position or type of work and location for which you wish to apply: Summer Temp/Project Are you willing to work hours other than 8-5? Yes Are you willing to travel? Yes Job Posting Number Closing Date Do you have any relatives working for this agency? If so, list names and relationships: List the state agency with which you wish to apply: Part-Time List any other names used if different from name on this application. Full-Time (Middle) MAILING ADDRESS (Street) ( ) Date available for work? Are you at least 17 years of age? Yes No What days are you unable to work? No If yes, what percent of time? No Current Driver's License # (if required for position) (State) Commercial Driver's License Yes No (Number) Geographic preference. (Be specific to city/area. If no preference, write "statewide.") Have you ever been convicted of a felony or subjected to deferred adjudication on a felony charge? Yes No If your answer is "Yes," explain in concise detail on a separate page, giving dates and nature of the offense, name and location of the court, and disposition of the case(s). A conviction may not disqualify you, but a false statement will. Note: Some state agencies may require additional information related to convictions of misdemeanors. EDUCATION (NOTE: Applicants may be required to provide proof of diploma, degree, transcripts, licenses, certifications, and registrations.) High School Graduate or GED? Yes No If yes, name and location of high school or GED institute: Type Dates Attended of School Name and Location of School From Mo. Yr. Date Mo. Expected Sem/Clock Type Major/Minor Graduated To Graduation Hours of Diploma Fields Date Completed or Degree of Study Yr. Graduate Schools Undergraduate Colleges or Universities Page 1 of 4 (0909)
- 2. Technical or Vocational Schools Page 1 of 4 (0909)
- 3. AN EQUAL OPPORTUNITY EMPLOYER If a license, certificate, or other authorization is required or related to the position for which you are applying, complete the following: LICENSE/CERTIFICATION Date Date Issued by/Location of issuing authority (P.E., R.N., Attorney, C.P.A., etc.) issued expires (State or other authority) (City & State) License No. Special Training/Skills/Qualifications: List all job related training or skills you possess and machines or office equipment you can use, such as calculators, printing or graphics equipment, computer equipment, types of software and hardware. (Attach additional page, if necessary.) Approximately how many words per minute do you type? Sign Language (If required for this position) Yes No Are you a certified interpreter? Yes Do you speak a language other than English? (If required for this position) Yes If yes, what language(s) do you speak? No How fluently? Fair Do you write in a language other than English? (If required for this position) Yes If yes, which language(s) Have you ever been employed by the State of Texas? Yes Good Excellent No No Are you currently employed by the State of Texas? Yes If you have been previously employed by the State of Texas, list the agency/agencies: FORMER FOSTER YOUTH (Verification may be required.) MILITARY SERVICE (A copy of a report of separation from the Armed Services may be required.) No Dates of Service (From/To): No Were you a foster youth under the Texas Department of Family and Protective Services on the day before your 18 th birthday? Yes If yes, are you currently 25 years of age or younger? Yes No Are you a veteran? Yes No If yes, list type of discharge No Are you a surviving spouse of a veteran who has not remarried? Yes If yes, complete dates of service for veteran No Are you a surviving orphan of a veteran? Yes No PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND INDICATE YOUR UNDERSTANDING AND ACCEPTANCE BY SIGNING IN THE SPACE PROVIDED 1. I certify that all the information provided by me in connection with my application, whether on this document or not, is true and complete, and I understand that any misstatement, falsification, or omission of information may be grounds for refusal to hire or, if hired, termination. I understand that as a condition of employment, I will be required to provide legal proof of authorization to work in the U.S. I understand that the State of Texas requires all males who are 18 through 25 and required to register with the Selective Service, to present either proof of registration or exemption from registration upon hire. I understand that some state agencies will check with the Texas Department of Public Safety, the Federal Bureau of Investigation or other organizations, for any criminal history in accordance with applicable statutes. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability from any damages which may result from furnishing such information to you. 2. 3. 4. 5. THIS APPLICATION MUST BE SIGNED SIGN HERE: X Signature – Applicant (0909) Page 2 of 4 Date
- 4. EMPLOYMENT HISTORY This information will be the official record of your employment history and must accurately reflect all significant duties performed. Summaries of experience should clearly describe your qualifications. 1. Include ALL employment. Begin with your current or last position and work back to your first. Employment history should include each position held, even those with the same employer. EMPLOYER ADDRESSES MUST BE COMPLETE MAILING ADDRESSES, INCLUDING ZIP CODE. Answer all questions and completely summarize your experience including technical and managerial responsibilities and any special training, skills and qualifications for each position you have held. 2. 3. If you need additional space to adequately describe your employment history, you may use this employment history sheet or attach a typed employment history providing the same information in the same format as this application form. Last Name First Middle Position Title: Employer: Mailing Address: City & State/ZIP: Employer’s Telephone No.: ( ) Immediate Supervisor Name: Title: Supervisor’s Telephone No.: ( ) Current/ Starting Date Leaving Date Technical If supervisory, number of employees you Mo. Day Yr. Mo. Day Yr. Final Salary Non-Managerial supervised: Supervisory/Managerial $ Summary of experience including special training/skills/qualifications you have used in the performance of this job: Full-Time Part-Time Summer Temp/Project Give average # of hours worked per week if part-time: Specific reason for leaving: Position Title: Employer: Mailing Address: City & State/ZIP Employer’s Telephone No.: ( ) Immediate Supervisor Name: Title: Supervisor’s Telephone No.: ( ) Current/ Starting Date Leaving Date Technical If supervisory, number of employees you Non-managerial Mo. Day Yr Mo. Day Yr. Final Salary Supervisory/Managerial . $ supervised: Summary of experience including special training/skills/qualifications you have used in the performance of this job: Specific reason for leaving: (0909) Page 3 of 4 Full-Time Part-Time Summer Temp/Project Give average # of hours worked per week if part-time:
- 5. For State Agency Use Only: APPLICANT EEO DATA FORM Applicant Number: ________________ Position Title: Immediate Supervisor Name: Full-Time The information requested is optional and is being collected for the purpose of reporting to Federal and Equal Employment Employer: Part-Time Mailing Address: and will not be considered as part of the application for employment. It will be separated from the application. Title: Summer Opportunity Agencies City & State/ZIP: Temp/Project Employer’s Telephone No.: ( ) Supervisor’s Telephone No.: Give average # ( ) Current/ Starting Date Leaving Date Technical of hours worked per 1. Job Posting Number Name (Type or Print) First If supervisory, number of employees you week if part-time: Middle Mo. Day Yr. Mo. Day 2. LastFinal Salary Non-managerial Yr. Supervisory/Managerial supervised: $ Summary of experience including special training/skills/qualifications you have used in the performance of this job: 3. Address 6. Sex M-Male F- Female City 7. Birth Date 9. Veteran Yes No State ZIP Code 4. Daytime Phone ( ) 5. Work Phone ( ) 8. Ethnic Origin W-White B-Black 10. Surviving Spouse of Veteran who has not remarried Yes No 13. How did you first find out about this job? 01 - Other State Employee 02 - Job Fair 03 - Professional Publication 04 - Recruitment Poster 05 - Television Specific reason for leaving: Position Title: Employer: Mailing Address: City & State/ZIP: Employer’s Telephone No.: ( ) Asian/Pac. P-Islander H-Hispanic 11. Orphan of Veteran Yes No Am. Ind/ I-Alaskan O-Other 12. Former Texas Foster Youth 25 yrs of age or younger Yes No 06 – Newspaper 11 - WorkInTexas.com Name of Newspaper 07 - College/University Career Day 08 - Human Resource/Personnel Office 12 - Other (specify): 09 – Radio 10 - Agency Web Site - Internet X Immediate Supervisor Name: Title: Supervisor’s Telephone No.: Signature (– ) Applicant Full-Time Part-Time Summer Temp/Project Give average # Date Current/ Starting Date Leaving Date Technical of hours worked per If supervisory, number of employees you week if part-time: Mo. Day Yr. Mo. Day Yr. Final Salary Non-managerial Supervisory/Managerial supervised: $ White (Not of Hispanic origin) – All persons having origins you have used in the performance Europe, North Summary of experience including special training/skills/qualificationsin any of the original peoples of of this job: Africa, or the Middle East. Black (Not of Hispanic origin) – All persons having origins in any of the Black racial groups of Africa. Hispanic – All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. Asian or Pacific Islander – All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samoa. American Indian or Alaskan Native – All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. AN EQUAL OPPORTUNITY EMPLOYER Specific reason for leaving: (0909)
- 6. For State Agency Use Only: APPLICANT EEO DATA FORM Applicant Number: ________________ Position Title: Immediate Supervisor Name: Full-Time The information requested is optional and is being collected for the purpose of reporting to Federal and Equal Employment Employer: Part-Time Mailing Address: and will not be considered as part of the application for employment. It will be separated from the application. Title: Summer Opportunity Agencies City & State/ZIP: Temp/Project Employer’s Telephone No.: ( ) Supervisor’s Telephone No.: Give average # ( ) Current/ Starting Date Leaving Date Technical of hours worked per 1. Job Posting Number Name (Type or Print) First If supervisory, number of employees you week if part-time: Middle Mo. Day Yr. Mo. Day 2. LastFinal Salary Non-managerial Yr. Supervisory/Managerial supervised: $ Summary of experience including special training/skills/qualifications you have used in the performance of this job: 3. Address 6. Sex M-Male F- Female City 7. Birth Date 9. Veteran Yes No State ZIP Code 4. Daytime Phone ( ) 5. Work Phone ( ) 8. Ethnic Origin W-White B-Black 10. Surviving Spouse of Veteran who has not remarried Yes No 13. How did you first find out about this job? 01 - Other State Employee 02 - Job Fair 03 - Professional Publication 04 - Recruitment Poster 05 - Television Specific reason for leaving: Position Title: Employer: Mailing Address: City & State/ZIP: Employer’s Telephone No.: ( ) Asian/Pac. P-Islander H-Hispanic 11. Orphan of Veteran Yes No Am. Ind/ I-Alaskan O-Other 12. Former Texas Foster Youth 25 yrs of age or younger Yes No 06 – Newspaper 11 - WorkInTexas.com Name of Newspaper 07 - College/University Career Day 08 - Human Resource/Personnel Office 12 - Other (specify): 09 – Radio 10 - Agency Web Site - Internet X Immediate Supervisor Name: Title: Supervisor’s Telephone No.: Signature (– ) Applicant Full-Time Part-Time Summer Temp/Project Give average # Date Current/ Starting Date Leaving Date Technical of hours worked per If supervisory, number of employees you week if part-time: Mo. Day Yr. Mo. Day Yr. Final Salary Non-managerial Supervisory/Managerial supervised: $ White (Not of Hispanic origin) – All persons having origins you have used in the performance Europe, North Summary of experience including special training/skills/qualificationsin any of the original peoples of of this job: Africa, or the Middle East. Black (Not of Hispanic origin) – All persons having origins in any of the Black racial groups of Africa. Hispanic – All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. Asian or Pacific Islander – All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samoa. American Indian or Alaskan Native – All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. AN EQUAL OPPORTUNITY EMPLOYER Specific reason for leaving: (0909)