Randall County Application

Human Resources Office
501 16th Street, Suite 302	(806) 477-1701
Canyon, Texas 79015	hr-payroll@randallcounty.gov

Position Sought:*
YesNo
If yes, Complete Authorization to Check Driving Record.
Name*

First NameMiddle InitialLast Name
Maiden Name
Address*

Street Address

CityState

Zip Code
Email Address*
example@example.com
Home Phone / Cell
Format: (000) 000-0000.
YesNo
If yes, when?
Full-TimePart-TimeTemporary
If applying for part-time work please describe the days and times you are available to work
Do you have any relatives employed by Randall County
How did you hear about this position?

PREVIOUS EMPLOYMENT: Please list all employment for the past 10 years, beginning with your current position and working backward. You may attach a resume to include additional information.
Employer 1
Address-1
Start Date of employment-1

MonthDayYear
Date
End Date of employment-1

MonthDayYear
Date
Last Rate of Pay-1
Position-1
Immediate Supervisor-1
Description of Work-1
Reason for Leaving-1
Who may we contact as a reference ? Name-1
Contact Position-1
Contact Phone Number-1
Format: (000) 000-0000.
Employer 2
Address-2
Start Date of employment-2

MonthDayYear
Date
End Date of Employment-2

MonthDayYear
Date
Last Rate of Pay-2
Position-2
Immediate Supervisor-2
Description of Work-2
Reason for Leaving-2
Who may we contact as a reference? Name-2
Contact Position-2
Contact Phone Number-2
Format: (000) 000-0000.
Employer 3
Address-3
Start Date of employment-3

MonthDayYear
Date
End Date of employment-3

MonthDayYear
Date
Last Rate of Pay-3
Position-3
Immediate Supervisor-3
Description of Work-3
Reason for Leaving-3
Who may we contact as a reference? Name-3
Contact Position-3
Contact Phone Number-3
YesNo
If so, please explain. (This question does not apply to a layoff or reduction in force for economic reasons).

Education
YesNo
YesNo
Please indicate all college degrees and/or applicable coursework:
School Name-1
Area of Study-1
Degree Received/Semester Hours-1
School Name-2
Area of Study-2
Degree Received/Semester Hours-2
School Name-3
Area of Study-3
Degree Received/Semester Hours-3
Please list all licenses and certifications you hold which you believe qualify you for the position you seek:
Type-1
Number-1
Expiration-1
Type-2
Number-2
Expiration-2
RELEVANT EXPERIENCE: Please list any additional experience, training, and skills which you believe qualifies you for the position you seek:
Please list all equipment office machines and computer programs you are able to operate which you believe will be useful in the position you seek
YesNo

ADDITIONAL INFORMATION
During the past 7 years, have you been convicted of, or have you pleaded guilty or no contest to a felony offense? If yes, please explain, including offense, date of conviction or plea, and state and county in which offense occurred:
If you need additional lines, please ask Human Resources for additional Criminal History pages.
By signing below, I certify that I have fully and accurately answered all questions and have given all information requested in this application for employment, and I understand that any wrong or incomplete information on this form may disqualify me for further consideration for employment or, if discovered after I am hired, may be grounds for my immediate termination. I understand that all such information is subject to verification by Randall County and hereby give my consent to Randall County to investigate my background and qualifications using any means, sources, and outside investigators at its disposal. I agree to undergo any type of drug and/or alcohol testing that Randall County may require. Finally, I understand that submission of this application does not necessarily mean that I will be hired, and that if I am hired, my employment will be at will, and either I or Randall County may terminate my employment at any time, with or without notice or reason.
Applicants Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Education