Employment Application Form - City of Palestine, Texas

This fillable "Employment Application Form" is a document issued by the Texas Health and Human Services specifically for Texas residents.

Download the PDF by clicking the link below and complete it directly in your browser or through the Adobe Desktop application.

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CITY OF PALESTINE
HUMAN RESOURCES
504 N. Queen Street
Palestine, TX 75801
Tele: 903.731.8421
Fax: 903.731.8461
City of Palestine, Texas
Employment Information Page
An Equal Opportunity Employer
Thank you for your interest in employment with the City of Palestine. The City of Palestine is an
equal opportunity employer and does not discriminate in employment practices based on race,
color, sex, religion, national origin, age, or disability. Reasonable accommodation for persons with
disabilities will be made upon request. Please provide at least 48 hours advance notice of your
need for an accommodation.
Information For Applicants
(Please Read Carefully)
The City of Palestine requires all individuals who wish to be considered for employment to
complete and sign a City of Palestine Employment Application Form. A resume may be
attached to the application but not substituted for the application. Incomplete applications will
not be processed.
Completed applications must be received in the Human Resources Office by 5:00 p.m. on the
date of the deadline to apply. Application forms postmarked by the date of the deadline to apply
may be accepted if received in a timely manner.
The application form and all attachments become the official property of the City of Palestine.
Any questions, concerns, and/or complaints regarding the application process should be
directed to the Human Resources Department.
The process takes a minimum of 2-3 weeks from the date of the deadline to apply; however,
some positions may take longer. The Hiring Department will contact applications selected for
interviews and will make the final hiring decision.
For information concerning the status of your application, please call the Human Resources
Department at (903) 731-8421.
All information on the application form and any attached resume you submit is subject to
verification by the Hiring Department or Human Resources Department. As a condition of
employment, applicants will be subject to a criminal background check, drug test, and
verification/review of driver’s license record. Applicants refusing to cooperate, failing to show
up for a scheduled appointment or failing to successfully pass required tests will be disqualified
for consideration of employment with the City of Palestine for a one year period.
CITY OF PALESTINE
HUMAN RESOURCES
504 N. Queen Street
Palestine, TX 75801
Tele: 903.731.8421
Fax: 903.731.8461
City of Palestine, Texas
Employment Information Page
An Equal Opportunity Employer
Thank you for your interest in employment with the City of Palestine. The City of Palestine is an
equal opportunity employer and does not discriminate in employment practices based on race,
color, sex, religion, national origin, age, or disability. Reasonable accommodation for persons with
disabilities will be made upon request. Please provide at least 48 hours advance notice of your
need for an accommodation.
Information For Applicants
(Please Read Carefully)
The City of Palestine requires all individuals who wish to be considered for employment to
complete and sign a City of Palestine Employment Application Form. A resume may be
attached to the application but not substituted for the application. Incomplete applications will
not be processed.
Completed applications must be received in the Human Resources Office by 5:00 p.m. on the
date of the deadline to apply. Application forms postmarked by the date of the deadline to apply
may be accepted if received in a timely manner.
The application form and all attachments become the official property of the City of Palestine.
Any questions, concerns, and/or complaints regarding the application process should be
directed to the Human Resources Department.
The process takes a minimum of 2-3 weeks from the date of the deadline to apply; however,
some positions may take longer. The Hiring Department will contact applications selected for
interviews and will make the final hiring decision.
For information concerning the status of your application, please call the Human Resources
Department at (903) 731-8421.
All information on the application form and any attached resume you submit is subject to
verification by the Hiring Department or Human Resources Department. As a condition of
employment, applicants will be subject to a criminal background check, drug test, and
verification/review of driver’s license record. Applicants refusing to cooperate, failing to show
up for a scheduled appointment or failing to successfully pass required tests will be disqualified
for consideration of employment with the City of Palestine for a one year period.
CITY OF PALESTINE, TEXAS
Voluntary Disclosure Statement
IM PORTANT: The City of Palestine is an Equal Opportunity Employer and does not discriminate against any individual
on the basis of race, color, sex, religion, national origin, age or disability. You are invited to complete the following
inform ation to assist us in complying with federal record keeping requirements. Your response shall remain
confidential, will be kept separately from your application, and shall in no way affect a decision regarding your
em ployment.
NAME:
G
G
G
G
AGE:
Under 40
Over 40
SEX:
Male
Fem ale
RACE/ETHNIC IDENTIFICATION
G
W hite
Includes persons having origins in any of the original peoples of Europe, North Africa, or Middle East.
G
Black
Includes persons having origins in any of the black racial groups of Africa.
G
Hispanic
Includes persons of Mexican, Puerto Rican, Cuban, Central, or South Am erican, or their Spanish
culture or origin, regardless of race.
Asian or
G
Pacific Islander
Includes persons having origins in any of the original peoples of the Far East, Southeast, Asian, the
Indian Subcontinent, or the Pacific Islands. This area includes: China, Japan, Korea, The Philippine
Islands, and Sam oa.
Am erican Indian
G
or Alaska Native Includes persons having origins in any of the original peoples of North Am erica and who m aintain
cultural identification through tribal affiliation or com m unity recognition.
VETERAN STATUS
G
None (includes those with insufficient m ilitary service to qualify for Veteran Status)
G
Non-Disabled Vietnam -era Veteran
G
Non-Disabled Veteran other than Vietnam Conflict
G
Disabled Vietnam -era Veteran
G
Disabled Veteran
AM ERICAN W ITH DISABILITIES ACT (ADA) STATUS
G
G
Do you have a disability under ADA?
Yes
No
(Physical or m ental im pairm ent that substantially lim its one or m ore life activities, record of such an im pairm ent,
or regarded as having such an im pairm ent.)
SOURCE OF REFERRAL:
How did you find out about us/this position?
G
G
G
G
G
W alk-in
City Em ployee
Job Line
Cable Television
Internet W eb Page
G
G
Radio
Professional Journal
G
G
Newspaper
Recruiting Drive
G
G
Job Fair
Other
EMPLOYMENT
APPLICATION
An Equal Opportunity Employer
City of Palestine, Texas
Specific position applying for:
Desired Salary:
Additional positions applying for:
G
G
G
Are you seeking
Full-time
Part-time
Temporary/Seasonal employment?
Date available for work
Middle Name
Last Name
First Name
Present Street Address
City
State
Zip Code
Home Telephone
Work Telephone
Email (optional)
G
G
If under 18 years of age, can you provide required proof of your eligibility to work?
Yes
No
G
G
Are you legally eligible to work in the U. S. ? (Verification will be required upon hire)
Yes
No
G
G
Have you ever served in the Armed Forces?
Yes
No
Date of Service:
to
Type of Discharge:
G
G
Are you currently a City employee?
Yes
No
If yes, list the department and position:
G
G
Have you ever been employed by the City? Yes
No
If yes, list the department(s) and dates below:
Department
Position
From
To
G
G
Are you related by blood or marriage to any current City of Palestine employee or current Council member? Yes
No
If yes, please provide the following information:
Department
Position
From
To
G
G
Have you been convicted of a DUI or DWI within the past 3 years?
Yes
No
G
G
Is your driver’s license presently restricted, suspended or revoked? Yes
No
If yes, give the reason:
Date it began
, and date ended (or will end)
Do you have charges pending or have you admitted guilt or been found guilty, including Deferred Adjudication, of committing a felony or Class A or
G
G
B misdemeanor? Note: Include offenses for which probation was granted, exclude minor traffic violations, but include DUI/DWI. Yes
No
If yes, explain in the space provided.
Date
Offense
County & State of Offense
Disposition
G
G
Are you currently on “lay-off” status and subject to recall?
Yes
No
G
G
Can you travel if a job requires it?
Yes
No
IMPORTANT: A conviction or deferred adjudication record will not be an absolute to bar employment. Factors such as nature of offense, date and relationship between offense and the position for
which you are applying will be considered. However, a false statement or omission of any information will bar employment
EDUCATION
Number of Years
Diploma/
Completed
Degree/
List Name and Address of Schools:
Certificate
High School or GED:
College or University:
Subjects Studied:
Vocational or Technical:
Subjects Studied:
JOB RELATED SKILLS AND/OR LICENSES AND CERTIFICATIONS
What skills or additional training do you have that are related to the job for which you are applying?
Typing (wpm) _______________
Ten-key by touch _______________
Computer software __________________________________________________________________________________
Heavy equipment ____________________________________________________
Technical/Skilled craft (mechanic, electrician, engineering, etc.) ________________________________________________
Maintenance skills (painting, custodial, grounds, etc.) ________________________________________________________
Supervisory/Management Skills _________________________________________________________________________
Customer Service/Interpersonal Relations _________________________________________________________________
Other special skills ___________________________________________________________________________________
Bilingual Skills
Language
Speak
Read
Write
_______________________
! Fluent ! Good ! Fair
! Fluent ! Good ! Fair
! Fluent ! Good ! Fair
_______________________
! Fluent ! Good ! Fair
! Fluent ! Good ! Fair
! Fluent ! Good ! Fair
_______________________
! Fluent ! Good ! Fair
! Fluent ! Good ! Fair
! Fluent ! Good ! Fair
NOTE: Applicants may be required to provide copies of licenses and certifications.
List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which
reveal race, color, religion, national origin, sex, age, disability or other protected status.)
Driver’s License Number ______________________________
License issued by the State of: _____________________
!
!
!
!
!
!
What type of license do you have? Commercial (CDL) Class
A
B
C or
Operators Class
A
B
C
Page 2
EMPLOYMENT HISTORY
List names of employers in consecutive order with present or last employer listed first.
Name of Employer
Supervisor(s) Name/Title
Address
Employed
From (mo/yr)
/
To (mo/yr)
/
City, State, Zip Code
!
!
May we contact this employer?
Yes
No
Telephone
Position Title
Reason for Leaving
Job Duties
Hourly Rate/Salary: Starting
Final
What did/do you like the most about this position? _____________________________, the least? ______________________________
Name of Employer
Supervisor(s) Name/Title
Address
Employed
From (mo/yr)
/
To (mo/yr)
/
City, State, Zip Code
!
!
May we contact this employer?
Yes
No
Telephone
PositionTitle
Reason for Leaving
Job Duties
Hourly Rate/Salary: Starting
Final
What did/do you like the most about this position? _____________________________, the least? ______________________________
Name of Employer
Supervisor(s) Name/Title
Address
Employed
From (mo/yr)
/
To (mo/yr)
/
City, State, Zip Code
!
!
May we contact this employer?
Yes
No
Telephone
Position Title
Reason for Leaving
Job Duties
Hourly Rate/Salary: Starting
Final
What did/do you like the most about this position? _____________________________, the least? ______________________________
Comments: Include explanation of any gaps in employment: __________________________________________________
__________________________________________________________________________________________________
!
!
Have you ever been discharged from any employment or asked to resign in lieu of discharge? Yes
No
If yes, specify the circumstances: _______________________________________________________________________
__________________________________________________________________________________________________
Page 3

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