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Personal Information

First Name*
Last Name*
Address1*
City*
State*
Zip*
Phone Number*
Email Address*
Have you ever been convicted of a violation of the law other than a minor traffic violation?*
1. Yes
1. No
Are you eligible to work in the United States?*
1. Yes
1. No
Have you ever submitted an application here before?
1. YES
2. NO
If necessary, best time to call you at home is:
1. AM - MORNING
2. PM - AFTERNOON
3. EVENING
IF SO WHEN?
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Position Information

Which position are you applying for?*
Type of employment desired*
1. Full Time
1. Part Time
1. Internship
Saraly desired*
Hours of work (per week) desired*
How did you hear about the position?*
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Education

High School
Address
College
Address
Degree
Other
Address
Degree
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Employment History

(From Most Recent)
Company
Position
Supervisor
Phone Number
Pay Rate
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for leaving employment?
Company
Position
Supervisor
Phone Number
Pay Rate
May we contact your previous supervisor/employer for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Company
Position
Supervisor
Phone Number
Pay Rate
May we contact your previous supervisor/employer for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
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References

Please list three professional references.
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
You will be asked to fill out and sign 1) Authorization for release of Criminal History 2) Disclosure and Consent to Procurement of an Investigative Consumer Report
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Step Six

APPLICANT STATEMENT
I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.
I understand that his employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only while position is open. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.
I also understand that if I am hired. I will be required to provide proof of identity and legal authorization to work in the United State and that federal immigration laws require me to complete an I-9 Form in this regard.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, plublic agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organization for furnishing such information about me.
If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. this application does not constitute an agreement or contact for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to made any assurances to the contrary and that no implied oral or written agreement contrary to the foregoing express language are valid unless they are in writing and signed by the employer's City Manager.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect it will be sufficient cause to 1) eliminate me from further consideration for employment, or 2) may resul in my immediate discharge from the employer's service whenever it is discovered.
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Disclaimer & Signature

I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*
CITY OF MATHIS - 411 E. SAN PATRICIO AVENUE - MATHIS, TEXAS 78368
"THIS INSTITUTION IS AN EQUAL OPPORTUNITY EMPLOYER."

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