MIDLAND COUNTY APPLICANT INSTRUCTIONS
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1 MIDLAND COUNTY APPLICANT INSTRUCTIONS HUMAN RESOURCES 500 N. Loraine, Suite 100 Midland, Texas (p) (f) Applications are accepted for posted (vacant) positions only. 2. Announcement number and job title must be on the application. 3. Please complete this application in type or legible print (using black or blue ink) 4. Resumes will not be accepted as a substitute for applications, but may be attached for additional information. Please do not write "see resume" for completing any portion of the application. 5. In order for your application to be considered complete, you must answer all questions in this application. AN INCOMPLETE APPLICATION WILL NOT BE CONSIDERED. If a question does not apply indicate "N/A" for non-applicable. 6. Applications and attachments, once submitted, become the property of Midland County Government and will not be returned to the applicant. 7. Applications are available at Human Resources or by download. Applications can be mailed or faxed to applicants who live outside Midland County. 8. The information you provide on this application should clearly reflect your suitability to the position you are applying for. Your employment record, position-related educational requirements, skills, knowledge, abilities, qualifications, and experience will be evaluated based upon the information you provide in this application. 9. Any information that you provide in this application, accompanying documents, and/or give verbally to Midland County is subject to verification. Falsification, misrepresentation, or omissions of fact may be grounds for rejection of your application, or subsequent termination of employment if hired. 10. A comprehensive pre-employment reference and background screening will be conducted on all applicants as permitted by law. (Original signatures are required on background form.) 11. This application becomes public record and is subject to disclosure in accordance with the Texas Government Code Ann. 552-Public Information Act. 12. Applications must be received by Human Resources by the date and time the posting closes. 13. Paper applications may be mailed, delivered in person, ed, or faxed at (432) to Human Resources. 14. You may apply in person between the hours of 8:00 a.m. and 4:00 p.m., Monday Friday. 15. Due to the volume of applications received, we are unable to advise applicants as to the status of their application. If your application meets the required qualifications for the position you are applying for, it will be forwarded to the respective department. A department representative will then contact you if they are interested in interviewing you. Thank you for your interest in employment with Midland County. UPON RECEIVING A CONDITIONAL OFFER OF EMPLOYMENT, ALL APPLICANTS ARE SCREENED FOR THE PRESENCE OF ILLEGAL DRUGS. An Equal Opportunity
2 MIDLAND COUNTY Employment Application Position Applied For: All applications for employment must be made on this form. Applicants are urged to consider carefully and understand fully each question and having done so, to fill in ALL blanks accurately. Neatness is important. Please use blue or black ink only. Resumes will be accepted as a supplement to the application but not in place of it. Incomplete applications will not be processed. Midland County only accepts applications for vacant positions. Midland County is an Equal Opportunity. Federal and State laws prohibit discrimination in employment practices because of race, color, religion, sex, age, national origin, or disability. : : City, State, Zip: Home Telephone: APPLICANT INFORMATION Last First MI Alternate Telephone: Are you at least 18 years old? Yes No Do you have a valid Driver s License? Yes No If hired, can you submit verification of your legal right to work in the United States? Yes No U.S. MILITARY SERVICE If you have served in the U.S. Military, please provide the following information: Branch of Service Served From Served To EDUCATION/SKILLS Educational Level City ST Years Completed Degree or GED Major High School Business/ Trade School College Graduate School 1 2 SOFTWARE KNOWLEDGE Software of Software Proficiency Word Processing Beginner Intermediate Expert Spreadsheet Beginner Intermediate Expert Database Beginner Intermediate Expert Other Beginner Intermediate Expert
3 Types of licenses and/or certifications LICENSES AND/OR CERTIFICATIONS Issued Registration Number State Expires EMPLOYMENT INFORMATION EACH CASE IS CONSIDERED SEPARATELY BASED ON JOB DUTIES AND PERFORMANCE AREAS Have you ever been convicted, or pled guilty or no contest to, a felony offense? If so, please explain. Important: for purposes of employment with Midland County, convictions include sentenced to confinement, paid fine, time served, placed on probation (including deferred adjudication) and court-ordered restitution. A conviction will not necessarily disqualify an applicant from employment. Yes No If yes, give location, date, charge and disposition of case(s); Location Charge Disposition Details ALL QUESTIONS MUST BE ANSWERED TO BE CONSIDERED COMPLETE. If the answer to any of the following questions is YES, list details in the remarks section (Attach additional sheet if necessary) Have you ever been fired or asked to resign from a job within the last 5 years? Yes No Have you ever been employed by Midland County? Yes No When? Department? Do you have a relative currently working for Midland County? If yes, please list their Department Remarks: Yes No REFERENCES
4 May we contact your current employer(s)? Yes No May we contact your past employer(s)? Yes No **LIST MOST CURRENT JOB FIRST** **INCLUDE ANY GAP IN EMPLOYMENT WITH AN EXPLANATION**
5 AUTHORIZATION I understand and agree that, if required for the position, I will submit to a pre-employment driving record check, criminal check and/or pre-employment physical, and in accordance with Midland County s adopted policies. I will submit to a pre-employment drug/alcohol screen as well as any other drug/alcohol screenings as required by Midland County s policy. I understand and agree that, if I refuse to submit to such physical, drug/alcohol screen, criminal check or driving record check, I will not be considered for employment with Midland County. I also understand that, once employed, refusal to submit to such exams or a positive result on a drug/alcohol screen will be grounds for disciplinary action, which may include termination. I hereby authorize Midland County, its representatives, employees or agents to conduct all pre-employment inquiries and tests as described. I further authorize Midland County and its agents to verify all statements contained in this application and any other materials I submit in connection with my employment application. I agree to complete any requisite authorizations forms. I release Midland County, its agents and all providers of information from any liability arising out of the gathering and use of such information. In the event of employment, this authorization and release is valid throughout my employment and a photocopy is as effective as the original. I understand all offers of employment are conditional upon satisfactory reference checks, successful completion of all preemployment tests and production of all documents necessary for Midland County to verify my identity and work authorization in accordance with the requirements of the Immigration and Naturalization Services. I certify the information provided in this application is true and complete to the best of my knowledge. I understand withholding pertinent information or submitting false or misleading information on this application, my resume, during interviews or at any other time during the hiring process constitutes valid grounds for disqualification from further consideration for hire or immediate dismissal from employment and loss of all employee benefits and privileges. I further understand and agree that Midland County shall not be liable in any respect if my employment is so denied or terminated. I understand the acceptance of this application by Midland County neither expresses nor implies I will be offered employment. I understand my employment is at will and I may resign at any time for any reason; similarly, my employment may be terminated by the organization at any time for any reason. Any changes to this at-will employment agreement will not be valid unless in writing signed by me and a duly authorized representative of Midland County. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE AUTHORIZATION SIGNATURE OF APPLICANT DO NOT WRITE BELOW THIS LINE FOR MIDLAND COUNTY USE ONLY Received: Background Check Tests Score Interview
6 Midland County Prospective Employee Background Check I hereby authorize the Midland County to perform a criminal history background check while I am being considered for possible employment. I understand there is no fee associated for this investigation and that the information will be kept strictly confidential to Midland County. Full : Other names used: (First & Last) (alias, maiden, nicknames) Street : City, State Zip: of Birth: Social Security Number: Driver s License Number: State Issuing DL: Prospective Employee Signature
7 DPS Computerized Criminal History (CCH) Verification (AGENCY COPY) I,, acknowledge that a Computerized Criminal APPLICANT or EMPLOYEE NAME (Please print) History (CCH) check will be performed by accessing the Texas Department of Public Safety Secure Website and will be based on name and DOB identifiers I supply. (This is not a consent form.) Authority for this agency to access an individual s criminal history data may be found in Texas Government Code 411; Subchapter F. -based information is not an exact search and only fingerprint record searches represent true identification to criminal history, therefore the organization conducting the criminal history check is not allowed to discuss with me any criminal history record information obtained using this method. The agency may request that I have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search. Once this process is completed the information on my fingerprint criminal history record may be discussed with me. In order to complete the process I must make an appointment with the Fingerprint Applicant Services of Texas (FAST) as instructed online at /Crime Records/Review of Personal Criminal History or by calling the DPS Program Vendor at , submit a full and complete set of fingerprints, request a copy be sent to the agency listed below, and pay a fee of $24.95 to the fingerprinting services company. This is completed only when Midland County requests it (This copy must remain on file by your agency. Required for future DPS Audits) Signature of Applicant or Employee Midland County Agency (Please print) Agency Representative (Please print) Please: Check and Initial each Applicable Space CCH Report Printed: YES NO initial Purpose of CCH: Empl Vol/Contractor initial Signature of Agency Representative Printed: Destroyed : initial initial Retain in your files Rev. 09/2013
MIDLAND COUNTY APPLICANT INSTRUCTIONS
MIDLAND COUNTY APPLICANT INSTRUCTIONS HUMAN RESOURCES & RISK MANAGEMENT 500 N. Loraine, Suite 100 Midland, Texas 79701 (p) 432-688-4855 (f) 432-688-4961 1. Applications are accepted for posted (vacant)
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