tarrant county 9-1-1 district

Employment Application

Tarrant County 9-1-1 District is an equal opportunity employer and makes employment decision without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age, veteran status or disability. All questions on this application are solely directed toward determining applicant qualifications for specific job requirements and no question is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law.

Applicant Information

Last Name

~Last Name~

First

~First Name~

M.I. ~M.I.~

Date

~Date~

Street Address

~Street Address~

Apt/Unit #

~Apt #~

City

~City~

State

~State~

ZIP

~ZIP~

Phone

~Phone~

E-mail Address

~Email~

Date Available

~Date Available~

Desired Salary

~Desired Salary~

Position Applied for

~Job Posting - Position~

POSITION REQUIREMENTS

Are you a citizen of the United States?

~Citizen?~

If no, are you authorized to work in the U.S.?

~Work in US?~

Have you ever been denied Security Clearance based on a background check?

~Security Clearance~

If yes, explain

~Security Explain~

Have you ever been convicted of a felony?

~Felony?~

If yes, explain

~Felony Explain~

Are you able to work flexible hours based on service needs?

~Flexible Hours?~

If no, explain

~Hours Explain~

Can you provide your own vehicle for transportation to and from job assignments?

~Vehicle?~

If no, explain

~Vehicle Explain~

Do you have a valid Driver?s License?

~DL?~

State ~DL State~

Driver License Number ~DLN~

EDUCATION

High School

~High School~

Address

~HS Address~

From

~HS From~

~HS To~

Did you graduate?

~HS Graduate?~

Degree

~HS Degree~

College

~College~

Address

~College Address~

From

~College From~

~College To~

Did you graduate?

~College Graduate?~

Degree

~College Degree~

Other

~Other Name~

Address

~Other Address~

From

~Other From~

~Other To~

Did you graduate?

~Other Graduate?~

Degree

~Other Degree~

Additional Education

~Additional Education~

APPLICABLE CERTIFICATIONS AND PROFESSIONAL CREDENTIALS

Please list all applicable certifications, licenses, or other professional acknowledgements

~Certifications/Credentials~

References
Please list three professional references.
Full Name	~Ref 1 Name~	Relationship		~Ref 1 Relationship~
Company	~Ref 1 Company~	Phone	~Ref 1 Phone~
Address	~Ref 1 Address~
Full Name	~Ref 2 Name~	Relationship		~Ref 2 Relationship~
Company	~Ref 2 Company~	Phone	~Ref 2 Phone~
Address	~Ref 2 Address~
Full Name	~Ref 3 Name~	Relationship		~Ref 3 Relationship~
Company	~Ref 3 Company~	Phone	~Ref 3 Phone~
Address	~Ref 3 Address~

Previous Employment (LIST MOST RECENT FIRST)

Company

~Emp 1 Company~

Phone

~Emp 1 Phone~

Address

~Emp 1 Address~

Supervisor

~Emp 1 Supervisor~

Job Title

~Emp 1 Job Title~

Starting Salary

$~Emp 1 Start Pay~

Ending Salary

$~Emp 1 End Pay~

Responsibilities

~Emp 1 Responsibilities~

From

~Emp 1 From~

~Emp 1 To~

Reason for Leaving

~Emp 1 Reason Leave~

Company

~Emp 2 Company~

Phone

~Emp 2 Phone~

Address

~Emp 2 Address~

Supervisor

~Emp 2 Supervisor~

Job Title

~Emp 2 Job Title~

Starting Salary

$~Emp 2 Start Pay~

Ending Salary

$~Emp 2 End Pay~

Responsibilities

~Emp 2 Responsibilities~

From

~Emp 2 From~

~Emp 2 To~

Reason for Leaving

~Emp 2 Reason Leave~

Company

~Emp 3 Company~

Phone

~Emp 3 Phone~

Address

~Emp 2 Address~

Supervisor

~Emp 3 Supervisor~

Job Title

~Emp 3 Job Title~

Starting Salary

$~Emp 3 Start Pay~

Ending Salary

$~Emp 3 End Pay~

Responsibilities

~Emp 3 Responsibilities~

From

~Emp 3 From~

~Emp 3 To~

Reason for Leaving

~Emp 3 Reason Leave~

I voluntarily consent to authorize Tarrant County 9-1-1 District or any of its officers, employees, or agents to check my references by contacting any person or entity whom they deem to be appropriate. I understand that questions may be asked about my educational background, work experience, achievements, wage history, performance, attendance, personal history, character, personality, disciplinary information and reason for separation from former employment.

I authorize persons, schools, my current employer if applicable, and previous employers and organizations contacted by Tarrant county 9-1-1 District to provide any relevant information regarding my current or previous employment and I release all persons, schools and/or employers of any and all claims for providing such information. It is expressly understood that any information given is to be used for the purpose of determining my acceptability for employment with Tarrant County 9-1-1 District.

I understand that misrepresentation or omission of facts may result in rejection of my application, or if hired, discipline up to and including dismissal.

Should I be extended a conditional offer of employment, I agree to submit to a fingerprint comparison of state and national Criminal History files for determination by the CJIS Division of the Texas Department of Public Safety of my eligibility to work in secure areas where sensitive criminal justice information is processed.

I also hereby release Tarrant Count 9-1-1 District from all liability for damages or claims?including but not limited to, defamation, interference with contract, and negligence?which may arise or result from any reference information gathered pursuant to this authorization.

By selecting the "I Accept", you agree that your typed name is your electronic signature and is the legal equivalent of your manual signature on this application.

Additional Employment
~Additional Employment~

Military Service
Branch	~Military Branch~			From	~Service Start~	To	~Service End~
Rank at Discharge		~Rank~
Duties Performed			~Duties~


Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment I understand that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. I further understand that false or misleading information in my application or interview may result in my release. I understand that Tarrant County 9-1-1 requires a drug free workplace and I consent to compliance with this policy as a condition of employment. I understand that, if a conditional offer of employment is extended, a full criminal history check based on finger print comparison will be completed and any offer of permanent employment is contingent upon confirmation by the CJIS Division of the Texas Department of Public Safety of my eligibility to work in secure areas where sensitive criminal justice information is processed. By selecting the "I Accept", you agree that your typed name is your electronic signature and is the legal equivalent of your manual signature on this application.
I Accept ~I Accept Ack~
Signature	~Akn Signature~	Date	~Akn Date~