McLennan County Community Supervision and Corrections Department (CSCD-Adult Probation Department) Applicant Information Sheet

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1 McLennan County Community Supervision and Corrections Department (CSCD-Adult Probation Department) Applicant Information Sheet McLennan County CSCD is an equal opportunity employer and encourages applications from eligible and qualified individuals regardless of race, color, religion, sex, national origin, age, or non-disqualifying disability. The following voluntary information will be used to track the overall effectiveness of the Department s recruitment efforts. The information will not be submitted to the hiring administrators or used in the hiring process. You are not required to complete this sheet to be considered for employment. Date Name Address Last Name First MI Street City State Zip Code Position Applying For: Vacancy Number Sex: Male Female Ethnic Origin (choose only one): White/Non-Hispanic Black/Non-Hispanic Hispanic Asian/Pacific Islander American Indian/Alaskan Native Age: Under Over 40 United States Veteran: Yes No Source of Referral (Choose only one): Walk in Job Line County Employee Waco Tribune Herald Texas Work Force Commission Other

2 McLENNAN COUNTY COMMUNITY SUPERVISION AND CORRECTIONS DEPARTMENT EMPLOYMENT APPLICATION ALL QUESTIONS MUST BE ANSWERED EMPLOYMENT DESIRED Position applying for Vacancy Number Salary desired Date available Are you employed now? If so, may we contact your present employer? Have you ever applied with McLennan County CSCD before? Position? When? PERSONAL INFORMATION Last Name First Name MI Address City State Zip Code Driver s License Number State Expiration Date Check Type of License Operator Commercial Chauffeur C B A Referred By: Social Security Number Home Telephone Number (w/area Code) Cell Telephone Number (w/area Code) Are you over 18 years of age? If not, employment is subject to verification of age. EDUCATION High School Attended and Location Did you Graduate? If not, do you have a GED? Major Major Major Trade, Business or Correspondence School Attended and Location

3 CITIZENSHIP Are you a U.S. Citizen? If no, do you have the legal right to work in the U.S.? If not a U.S. Citizen, proof of the right to work in the United States must accompany this application. U.S. MILITARY SERVICE if Yes complete below. Dates of service Duties (from / to) REFERENCES Name Address Phone EMPLOYMENT HISTORY Provide employer information for last 10 years and any other work you feel is relevant to the position you have applied for. Attach additional sheets if necessary. (ALL QUESTIONS MUST BE ANSWERED) (1) Present or last employer (Include address) Phone No. (w/area Code) (2) Previous employer (Include address) Phone No. (w/area Code)

4 (3) Previous employer (Include address) Phone No. (w/area Code) (4) Previous employer (Include address) Phone No. (w/area Code) (5) Previous employer (Include address) Phone No. (w/area Code) (6) Previous employer (Include address) Phone No. (w/area Code)

5 (7) Previous employer (Include address) Phone No. (w/area Code) SPECIAL SKILLS / QUALIFICATIONS List all special skills you possess and/or machines or office equipment you can use, such as calculators, computer equipment, types of software/hardware, etc. Other courses work applicable to this type of work: PRE-EMPLOYMENT STATEMENT I authorize the McLennan County CSCD to make any inquiries they desire regarding my education, employment, ability, habits and personal character for the purpose of determining my fitness for employment. I also authorize previous employers, or any other persons to whom the CSCD may refer, to give any and all information regarding my employment or scholastic record together with any information, personal or otherwise, and I hereby release such persons and any companies which they represent from all liability or any damages what so ever in connection with their compliance. I understand that misrepresentation or omission of any information called for in this application which would affect my application unfavorably, or receipt of unsatisfactory references may result in termination of my employment without liability to me for salary except as may have been earned at the time of my termination. If employed I understand that my employment with the CSCD will be at will, meaning that either the CSCD or myself may terminate the employment relationship at any time, for any reason or no reason at all with or without notice of any kind. APPLICANT S SIGNATURE (If submitted electronically print your name below.) DATE EQUAL OPPORTUNITY EMPLOYER McLennan County CSCD does not discriminate on the basis of race, color, religion, sex, national origin, age or disability in employment or provision of services.

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