Employment Application Packet - CITY OF JERSEY VILLAGE, Texas

This "Employment Application Packet" is a document issued by the Texas Workforce Commission specifically for Texas residents with its latest version released on February 1, 2011.

Download the up-to-date fillable PDF by clicking the link below or find it on the forms website of the Texas Workforce Commission.

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AN EQUAL OPPORTUNITY EMPLOYER
APPLICATION FOR EMPLOYMENT
CITY OF JERSEY VILLAGE, TEXAS
16501 Jersey Drive
Jersey Village, Texas 77040
Please write legibly, or type, and use black ink. Answer all questions completely. If an item does not
apply, write “N/A” for “Not Applicable”. Make sure all information is accurate. Information given may
be checked and any misstatement or omission is grounds for rejection (or dismissal if already employed).
Any applicant requiring an accommodation during any phase of testing for the position sought must
notify Personnel at the time the application is submitted. The information on this application and all
attached items are the property of the City of Jersey Village and for its use only. Applications must be
submitted by 5:00 p.m. on the stated closing date, if applicable, or will not be considered. If interested in
more than one vacancy, a separate application must be completed for each position.
Position Applied For
Date
Home Phone
Alternate Phone
Name (First)
(Middle)
(Last)
Social Security #
Mailing Address (Street, City, State, Zip Code)
Have you ever used another name? Yes
No
Name(s)_______________________________
Previously employed by the City of Jersey Village?
Yes
No
When?_____________ Under what name?_____________ In what department?____________
Do you have legal right to reside and work in the United States of America?
Yes
No
Proof of citizenship or work authorization will be required for employment
Do you have relatives employed by the City of Jersey Village?
Yes
No
What department?_____________ Their name?_____________ Relationship?_____________
Circle all types of work you will accept:
Permanent Full-Time Daytime Shifts Temporary Part-Time Night Work Weekends Internship
Date available for work ______________ Desired Salary Range__________________________
Do you have a valid Texas Drivers License? Yes
No
License #____________ Type _________
Have you ever been convicted or pleaded no contest for any offense other than parking violations?
Yes
No
Details (such as charges, penalties, where, when, currently on parole, probated sentence, etc.) ________
________________________________________________________________________
Have you ever been dismissed and/or allowed to resign in lieu of discharge?
Yes
No
If yes, specify the employer(s) and circumstances______________________________________
________________________________________________________________________
Are you able to meet the schedule/attendance requirements of the position? Yes
No
Are you willing to work more than 40 hours per week, if required?
Yes
No
Are you fluent in a foreign language? Yes
No
Language(s) ___________________________
Read? Yes
No
Write? Yes
No
Page 1 of 5
AN EQUAL OPPORTUNITY EMPLOYER
APPLICATION FOR EMPLOYMENT
CITY OF JERSEY VILLAGE, TEXAS
16501 Jersey Drive
Jersey Village, Texas 77040
Please write legibly, or type, and use black ink. Answer all questions completely. If an item does not
apply, write “N/A” for “Not Applicable”. Make sure all information is accurate. Information given may
be checked and any misstatement or omission is grounds for rejection (or dismissal if already employed).
Any applicant requiring an accommodation during any phase of testing for the position sought must
notify Personnel at the time the application is submitted. The information on this application and all
attached items are the property of the City of Jersey Village and for its use only. Applications must be
submitted by 5:00 p.m. on the stated closing date, if applicable, or will not be considered. If interested in
more than one vacancy, a separate application must be completed for each position.
Position Applied For
Date
Home Phone
Alternate Phone
Name (First)
(Middle)
(Last)
Social Security #
Mailing Address (Street, City, State, Zip Code)
Have you ever used another name? Yes
No
Name(s)_______________________________
Previously employed by the City of Jersey Village?
Yes
No
When?_____________ Under what name?_____________ In what department?____________
Do you have legal right to reside and work in the United States of America?
Yes
No
Proof of citizenship or work authorization will be required for employment
Do you have relatives employed by the City of Jersey Village?
Yes
No
What department?_____________ Their name?_____________ Relationship?_____________
Circle all types of work you will accept:
Permanent Full-Time Daytime Shifts Temporary Part-Time Night Work Weekends Internship
Date available for work ______________ Desired Salary Range__________________________
Do you have a valid Texas Drivers License? Yes
No
License #____________ Type _________
Have you ever been convicted or pleaded no contest for any offense other than parking violations?
Yes
No
Details (such as charges, penalties, where, when, currently on parole, probated sentence, etc.) ________
________________________________________________________________________
Have you ever been dismissed and/or allowed to resign in lieu of discharge?
Yes
No
If yes, specify the employer(s) and circumstances______________________________________
________________________________________________________________________
Are you able to meet the schedule/attendance requirements of the position? Yes
No
Are you willing to work more than 40 hours per week, if required?
Yes
No
Are you fluent in a foreign language? Yes
No
Language(s) ___________________________
Read? Yes
No
Write? Yes
No
Page 1 of 5
CITY OF JERSEY VILLAGE, TEXAS
EMPLOYMENT APPLICATION, continued
Circle highest grade completed:
6
7
8
9
10
11
12
13
14
15
16
17
18
Name and Location of High School________________________________________________
________________________________________________________________________
Did you graduate? Yes
No
GED Certificate? Yes
No
College
Date
Semester
Type
Attended
Location
From/To
Hours
Major
Minor
Degree
Date
Please list any other training, education, or certifications that would further qualify you for the position
________________________________________________________________________
________________________________________________________________________
Please list your machine/equipment skills that would further qualify you for the position___________
________________________________________________________________________
________________________________________________________________________
Please list your PC software skills that would further qualify you for the position_________________
________________________________________________________________________
________________________________________________________________________
List names, addresses, and phone numbers of three persons, other than relatives, who have worked with
you and who have knowledge of your character, experience, and abilities:
Name
Address
Telephone #
Page 2 of 5
CITY OF JERSEY VILLAGE, TEXAS
EMPLOYMENT APPLICATION, continued
Beginning with the most recent, list below jobs held (for the past 10 years) and any other experience
related to the position for which you are applying. Include military and volunteer experience. Specifically
describe duties performed. You may attach a resume, but simply stating “See Resume” on the application
is not acceptable. All information must be completed. If you need additional space, you may attach a
separate sheet, but it must contain the same informational categories as indicated on the application.
Last or Current Employer
Starting Date
Ending Date
Total Months Employed
Address
City/State
Phone
Your Position
Starting Salary
Ending Salary
Your Job Duties
Reason for Leaving
Previous Employer
Starting Date
Ending Date
Total Months Employed
Address
City/State
Phone
Your Position
Starting Salary
Ending Salary
Your Job Duties
Reason for Leaving
Previous Employer
Starting Date
Ending Date
Total Months Employed
Address
City/State
Phone
Your Position
Starting Salary
Ending Salary
Your Job Duties
Reason for Leaving
Page 3 of 5
CITY OF JERSEY VILLAGE, TEXAS
EMPLOYMENT APPLICATION, continued
FAILURE TO COMPLETE THIS APPLICATION FOR EMPLOYMENT IN ITS ENTIRETY OR
TO ATTACH APPLICABLE INFORMATION WILL ELIMINATE YOUR APPLICATION FROM
FURTHER CONSIDERATION.
PLEASE READ CAREFULLY AND SIGN BELOW
I understand that if I am hired, it will be at the discretion of the City of Jersey Village. I understand that
City employment is “At Will”, which means that the City has no obligation to continue to employ me in the
future, if I am hired.
I certify that the information given by me in this application and any attached information is true and
complete. I understand and agree that any false information, misrepresentation, or concealment of facts is
sufficient grounds for either my immediate discharge without recourse or refusal of employment by the City
of Jersey Village.
I authorize any of the persons, organizations, and educational institutions referenced in this application or
attached information to give hiring officials of the City of Jersey Village any and all information concerning
my previous employment, volunteer experience, education, motor vehicle record, criminal record, or any
other information they might have, personal or otherwise, with regard to any of the subjects referenced by
this application and I unconditionally and irrevocably release all such parties from all liability from any
damages which may result from furnishing such information to the City of Jersey Village.
I hereby authorize the City of Jersey Village to investigate and verify any representations made by me,
either orally or in writing. I hereby release the City 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
account of compliance, or attempts to comply, with this authorization. I am also aware 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 Jersey Village and will become a part of my personnel file if I
am hired.
I also understand that if I receive an offer of employment, such offer is conditional based on the successful
passing of any applicable job-related testing or screening that is required as a condition of employment,
including substance abuse screening and physical examination.
Signature of Applicant_______________________________ Date________________
Page 4 of 5
CITY OF JERSEY VILLAGE, TEXAS
PERSONNEL DEPARTMENT
Voluntary Applicant Information Form
TO BE COMPLETED BY APPLICANT:
Various agencies of the United States Government require employers to maintain information on applicants
pertaining to factors such as race, sex, veteran status, and type of position to which an individual applies. The
information requested on this form is for compliance with certain record keeping requirements. The City of
Jersey Village believes all persons are entitled to equal employment opportunities and does not discriminate
against employees or applicants for employment because of race, color, sex, religion, national origin, disability,
veteran status, age, marital status, or any other protected group status. The information collected on this form
will not be used for hiring, placement, or any other decision relating to terms and conditions of employment.
Completion of this form is voluntary. Failure to complete this form will not affect your application status.
Please ask for assistance if you have difficulty completing this form. The City of Jersey Village thanks you for
your assistance and cooperation.
PLEASE PRINT
LAST NAME
FIRST NAME
MIDDLE NAME
SOCIAL SECURITY NUMBER
BIRTH DATE
RACE/ETHNIC (Definition Below)
CAUCASIAN
SEX
VETERAN
BLACK
HISPANIC
MALE
YES
AMERICAN INDIAN
FEMALE
NO
/ALASKA NATIVE
ASIAN OR PACIFIC ISLANDER
POSITION APPLIED FOR
THROUGH WHAT SOURCE DID YOU LEARN ABOUT THIS JOB?
SIGNATURE
DATE
The Race/Ethnic designations used by the Equal Employment Opportunity Commission are outlined as follows:
CAUCASIAN
All persons having origins in any of the original peoples of Europe, North Africa, or the Middle
East (not of Hispanic Origin).
BLACK
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 origin, regardless of race.
AMERICAN INDIAN
All persons having origins in any of the original peoples of North America, and who maintain
OR ALASKA NATIVE
cultural identification through tribal affiliation or community recognition.
ASIAN OR PACIFIC
All persons having origins in any of the original peoples of the Far East, Southeast Asia, the
ISLANDER
Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan,
Korea, the Philippine Island, and Samoa.
NOTE: Prior to 1978 people from the Indian Subcontinent were classified “Caucasian”; however, that designation has been changed. Now
people from the Indian Subcontinent are to be classified as “Asian or Pacific Islander”. The Indian Subcontinent is comprised of
Bangladesh, Bhutan, India, Nepal, Pakistan, Sikkim, and Sri Lanka.
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