Application for Employment (for non-Sheriff jobs)

Date

MM slash DD slash YYYY

Position Applied For

Department

Name (Last, First, Middle)

Contact Number

Maiden Name or Other Names Used

Email

Address

Street Address City State / Province / Region ZIP / Postal Code

Have you ever worked for Kaufman County?

If so, when?

Which Department

Elected Official or Department Head Name

Are you authorized to work in the county?

Proof of citizenship or immigration status will be required upon employment

Do you have relatives working for Kaufman County

If yes, what department?

Relationship

Are you willing to travel if required by the job?

Are you willing to work:

Full time
Part tme
Temporary
Shift work

Check all that apply

Are you able to perform the essential functions of the job for which you are applying with or without reasonable accomodations?

Have you ever been convicted, pled guilty, pled no contest, received deferred adjudication or probabation for any criminal act?

A criminal conviction is not necessarily a bar to employment. False statements or omissions of information, whether intentional or unintentional, will be grounds for immediate elimination from further consdieration (or dismissal from employment with Kaufman County if hired).

If yes, list ALL such offenses and state date, name of Court and disposition

You may omit minor traffic violations for which you paid a fine of $200 or less

Are you under indictment for any crime?

If yes, state nature of indictment, date, and location of case(s).

Are you currently employed?

If yes, may we contact your present employer?

List all counties and states you have resided in the past 10 years

EMPLOYMENT HISTORY

List all employment (inlcuding military service) for at least the past 4 years. Begin with your present position and work back. The "reason for leaving" and 'salary" must be completed

Current or last employer

Dates of employment

Address of current or most recent employer

Address City, State, Zip

Phone number of current or most recent employer

Supervisor's Name

Current or most recent job title

Current or most recent salary/hourly rate

Description of current or most recent work

Reason for leaving/wanting to leave current or most recent employment

Previous employment (1)

Address of previous employer (1)

Address City, State, Zip

Dates worked at previous employment (1)

Phone number of previous employment (1)

Job title of previous employment (1)

Previous employment (1) salary/hourly rate

Previous employment (1) supervisor's name

Previous employment (1) description of work

Reason for leaving previous employment (1)

Previous employment (2)

Dates of previous employment (2)

Address of previous employment (2)

Address City, State, Zip

Previous employment (2) Phone

Previous employment (2) job title

Previous employment (2) salary/hourly rate

Previous employment (2) supervisor's name

Previous employment (2) description of work

Reason for leaving previous employement (2)

Please explain all periods of unemployment exceeding 90 days

EDUCATION

Applicants may be required to provide copies of transcipts and /or certficates/diplomas

Are you a High School graduate?

If no, last grade completed

Have you obtained a GED

Education

Name and Address of School #1	Years Completed #1	Major Area of Study #1	Diploma or Degree #1

Education

Name and Address of School #2	Years Completed #2	Major Area of Study #2	Diploma or Degree #2

Education

Name and Address of School #3	Years Completed #3	Major Area of Study #3	Diploma or Degree #3

Education

Name and Address of School #4	Years Completed #4	Major Area of Study #4	Diploma or Degree #4

REFERENCES

Provide the names and address of three (3) persons, other than relatives, who have knowledge of your character, experience, or ability.

Reference (1)

Name Street Address City State / Province / Region ZIP / Postal Code

Reference (1)

Phone	Occupation	Relationship	Years known

Reference (2)

Name Street Address City State / Province / Region ZIP / Postal Code Country

Reference (2)

Phone	Occupation	Relationship	Years known

Reference (3)

Name Street Address City State / Province / Region ZIP / Postal Code Country

Reference (3)

Phone	Occupation	Relationship	Years known

Do you speak any foreign language

If yes, what languages?

Do you have a Commercial Driver's License?

If yes, what classification of CDL do you have?

List any additional experience and training you have had in your opinion would qualify you for the position you are seeking

Have you ever served in the Military

If yes, which branch?

List any relevant job-related skills during your military service

Please indicate your experience/skills/abilities in the following areas:

Check all that apply

If other selected, please describe

Please indicate your experience/skills/abilities in the following areas:

Check all that apply

If other Selected, Please describe

Please indicate equipment operated

Check all that apply

If other selected, please describe

Acknowledgement

I acknowledge I have read and understand the following:

I certify that the answers given herein are true and complete. I understand that any falsification or willful omission made in my application, resume or interview(s) shall be sufficient cause for dismissal or refusal of employment, whenever discovered. I understand that the information provided in my application, resume and interviews may be investigated, and I hereby authorize each former employer, whether given as a reference or not, to answer any questions and furnish any information sought by Kaufman County concerning any qualifications for employment. I understand that a background investigation which may include a full criminal history, FBI records check and driver’s license check will be conducted. I hereby release Kaufman County and all third parties supplying information to Kaufman County from all liability, including liability caused by negligence, arising from reference and background checks conducted by or on behalf of the employer about me. I also understand that this application is subject to the Open Records Act and may be released as a public document.
understand that my employment is at the discretion of the Commissioners’ Court, Elected Official, or Department Head concerned, and that Kaufman County is an employment-at-will employer, which means that I may resign at any time and Kaufman County may terminate my employment at any time for any or no reason.
I understand that my employment is contingent upon successful completion of a background investigation, driving record and drug screening. I understand that a positive result from the drug screen will eliminate me from consideration from any Kaufman County job for one year.
I understand that Kaufman County has an Employee Personnel Policy Manual, which describes additional obligations, terms and conditions of employment. If selected for employment with Kaufman County, I agree to promptly familiarize myself with the terms of such document and abide thereby. I understand and agree that all benefits, programs, rules and policies of Kaufman County are subject to exceptions or change at any time, as decided by Kaufman County.
certify that I have carefully read each provision of this application for employment and that I have been given an opportunity to ask questions concerning any provision, which I do not fully understand.

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Kaufman County not to discriminate in employment on the basis of race, religion, color, age, national origin, sex, marital status, veteran status or disability. To request a reasonable accommodation or other assistance, contact the Human Resources Department at 972-932-0283, or mail your request to the address above.Kaufman County is an Equal Opportunity Employer. We request that you provide the following information, which is used to study recruitment and employment patterns and to provide statistical data to federal compliance agencies. This information will be kept separate from your application and kept confidential and will in no way be used in consideration of your application for employment. Completion of this portion of the form is voluntary. Failure to provide this information will not jeopardize your opportunity for employment with Kaufman County.

Check the most appropriate blanks:

If other seleceted, please specify

What led you to apply with Kaufman County

If referred by an employee, please provide the employee's name

If other selected, please specify

Application for Employment (for non-Sheriff jobs)