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Position Applying For:
Date Applying

                                                                            ***TO THE APPLICANT ***                                                                                     

INSTRUCTIONS: Please complete, sign, and submit this form. Applications must complete all the blanks accurately, completely, and legibly to be considered. We may verify all information you provide. A FALSE STATEMENT OR OMISSION MAY RESULT IN DISQUALIFICATION FOR EMPLOYMENT OR DISCHARGE, IF EMPLOYED.


The City of Freeport is an Equal Opportunity Employer. In Accordance with Civil Rights Acts of 1964 and 1991, as amended, the Age Discrimination in Employment Act, and the Americans with Disabilities Act, the City of Freeport prohibits discrimination in employment because of race, color, sex, religion, national origin, age or disability. 


No question on this application is intended to secure information or to be used for discriminatory purposes. 
Applicant Name:
Other Names Used:
Your Address:
City, State, Zip Code:
Email:
Home Phone Number:
Alt Phone Number:
Have you been issued a citation for any moving traffic violations within the past three years?
If any are yes please explain and list the dates, violations, locations, and results:
Have you ever had your driver's license suspended or revoked?
Have you ever served in the Armed Services? (if no please skip to next section)
Branch
Dates Served:
Are you in the Reserves?
Have you ever pled guilty or no contest, been convicted, placed on deferred adjudication or community supervision for a felony or a misdemeanor offense in a civilian or military court? (if no please skip to next section)
Charge(s)
 
Arrest date(s):
Location(s)
Result(s)
NOTE:  Prior to employment, applicants will be investigated as to convictions for prior criminal offenses.  Answering "yes" will not automatically disqualify you; however, a false statement or omission of information will.  A prior conviction will be considered in relationship to the requirements of the job.  Failure to answer the above questions truthfully will result in immediate dismissal.   
Please select all that you are available for work






If hired, can you show proof that you are legally eligible to work in the US:
If hired, can you show proof of age:
Are You at least 18 years of age:
Date you will be able to start:
Minimum Salary Requirements:
How did you learn about this position? (select 1)




Or Referred By
Have you ever been employed by the City of Freeport?
 
Do you have any relatives, by blood or marriage, working for or holding office for the City?
If Yes, when, in which department, and who was your supervisor:
If Yes, list name, division, and relation:

In accordance with Federal Privacy Act of 1974, disclosure of your Social Security Number is voluntary and will be used for identification purposes to ensure proper records are obtained.

 Notice to Employers: Solicited applications must be retained for one year from date of application. (Civil Rights Act of 1964)

What is your highest education level:
College, Business, or Technical Schools attended
Course/Major
Hours and Degree
Special Training Schools Attended:
Dates:
Course/Major and/or Degree Received
License/Certification (P.E., R.N., C.P.A., etc.):
License Number & Expiration Date:
Issued by (state or other authority):
Location of Issuing Authority
Date Issued:
Do you have equipment operations certifications/licenses?
Do you have a commercial driver's license?
Check all applicable endorsements:


List types of equipment you are able to operate:
List computer programs that you are profficient in:
Do you speak/read another language:
If Yes Which language:
How many WPM can you type:
List any further qualifications and skills you posess which are required for the job in which you are applying for:
List four people whom you have known for at least four years -- **Do not include relatives or employers listed on this application:** include names, addresses, telephone number, and relationship.
Name & Relationship:1
Name & Relationship:2
Name & Relationship:3
Name & Relationship:4
Address:1
Address:2
Address:3
Address:4
Telephone Number:1
Telephone Number:2
Telephone Number:3
Telephone Number:4
Start with your present or most recent experience and work backward, listing all work experience for the past ten (10) years. Attach extra sheets if needed. Experience may be paid or unpaid, full-time, part-time or military service. Resumes may not be submitted in place of employment history; however they may be attached as supplement to your application. If you fail to provide complete information, the City may disqualify your application. Please explain all gaps in employment history.
Employer's Name:1
Supervisor's Name:1
Type of Business:1
Duties and Responsibilities:1
Employer's Address:1
Supervisor's Title:1
Dates Employed:1
May we contact this employer:1
Employer's Phone Number:1
Your Title:1
Reason for Leaving:1
Starting Salary:1
Final or current Salary:1
Employer's Name:2
Supervisor's Name:2
Type of Business:2
Duties and Responsibilities:2
Employer's Address:2
Supervisor's Title:2
Dates Employed:2
May we contact this employer:2
Employer's Phone Number:2
Your Title:2
Reason for Leaving:2
Starting Salary:2
Final Salary:2
Employer's Name:3
Supervisor's Name:3
Type of Business:3
Duties and Responsibilities:3
Employer's Address:3
Supervisor's Title:3
Dates Employed:3
May we contact this employer:3
Employer's Phone Number:3
Your Title:3
Reason for Leaving:3
Starting Salary:3
Final Salary:3
Employer's Name:4
Supervisor's Name:4
Type of Business:4
Duties and Responsibilities:4
Employer's Address:4
Supervisor's Title:4
Dates Employed:4
May we contact this employer:4
Employer's Phone Number:4
Your Title:4
Reason for Leaving:4
Starting Salary:4
Final Salary:4
Employer's Name:5
Supervisor's Name:5
Type of Business:5
Duties and Responsibilities:5
Employer's Address:5
Supervisor's Title:5
Dates Employed:5
May we contact this employer:5
Employer's Phone Number:5
Your Title:5
Reason for Leaving:5
Starting Salary:5
Final Salary:5
Employer's Name:6
Supervisor's Name:6
Type of Business:6
Duties and Responsibilities:6
Employer's Address:6
Supervisor's Title:6
Dates Employed:6
May we contact this employer:6
Employer's Phone Number:6
Your Title:6
Reason for Leaving:6
Starting Salary:6
Final Salary:6
Press ENTER key to focus on the active panel
I am aware that this application may be subject to public disclosure unless an exception under the Texas Open Records Act is applicable.
 
The information in this application is accurate, complete, and is subject to verification by the City of Freeport. I understand that if I have given any false information in this application or If I have omitted any material facts, I may be disqualified from employment with the City of Freeport or if hired, I may be discharged immediately upon discovery of such false statements or omissions.
 
I also understand that the city of Freeport is an "employment-at-will" employer and that the acceptance of an offer of employment does not create a contractual obligation upon the City of Freeport to continue to employ me in the future.
 
PLEASE READ CAREFULLY and then initial each statement below to indicate you do understand and agree with the statement. 
 

I HAVE READ, UNDERSTAND, AND AGREE THAT:

please read the following and answer with your initials to acknowledge you understand and agree with the statement.
If I misrepresent or deliberately omit a fact in my application, the City may be justified in refusing employment to me or, if I am already employed by the City, in terminating my employment
If hired, I can be terminated or transferred to another position with or without cause at any time at the option of the City of Freeport
Only the City Manager has the authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing paragraph 2, and that no such agreement has been offered to anyone as part of this application process
No one with the City of Freeport may contract me for employment except by an explicit written contract authorized by the City Manager
If requested by the management at any time, I agree to a search of any locker or premises assigned to me and I hereby waive all claim for damages on account of such examination
I consent to medical and/or psychological exams as required or requested by the City of Freeport as permitted under applicable law
In order to assist the City Manager in determining my ability to perform the duties of any job after I receive an employment offer or during the course of my employment with the City of Freeport, I agree to sign and have notarized a Medical Record Authorization of any physician or hospital to release to the City Manager all records which the City Manager may deem appropriate
If I become employed by the City of Freeport, such employment is for an indefinite period of time and that the City of Freeport can change wages, hours of employment, shift assignments, benefits, positions, and conditions of employment at any time
I authorize the City of Freeport to consider my employment and to make any contacts it deems necessary (including, but not limited to employers, agencies of public record, or credit reporting agencies as allowed by the Fair Credit Reporting Act.). I understand that driving records and criminal background records may be obtained
Any overtime I receive can be paid in the form of compensatory time at the sole discretion of the City of Freeport
This application is the property of the City of Freeport and will become a part of my personnel file if I am accepted for employment. I further understand that this is an application for employment and that no employment is being offered by the City of Freeport, by receiving this application, has made no contract of employment with me and has not in any way guaranteed my future employment
Depending on the nature of the position I am seeking, I understand the City of Freeport may conduct pre-employment testing, including an agility test, to assess my qualifications for a particular position. If I require accommodation when the City administers pre-employment tests, I will notify the Human Resource Department, in writing, of any accommodation requirements when I submit my application
If I am offered employment, and again depending on the nature of the position I am seeking, I may be required to complete a post-offer physical examination and/or a drug screen at the expense of the City, If such a physical examination and/or drug screen is necessary, the job offer is conditional on the results of the medical and/or drug examination
I shall never construe this application or any other communication, verbal or written, given or made by anyone during the process of my applying for possible employment by the City of Freeport as constituting either a contract of employment or a guarantee of employment with the City of Freeport. I understand that this application is not an employment agreement
The City of Freeport does not in any manner guarantee my future employment in any particular position and, indeed, the City reserves both the right to terminate me or any employee in accordance with the law or to transfer me, or any employee to other positions as situations dictate
DISCLAIMER: By typing your name in the fields requesting it below and on any following section, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
I fully understand and agree to the stipulations listed above Signature of Applicant:
Today's Date Signed: Please enter today's date
I authorize any person or organization listed in this application and/or whose name I have given as a character reference and/or by whom I have been previously employed and/or any educational institution I have listed on this application to furnish any information they may have concerning me to the City of Freeport. I understand that the information provided by me may be used for the purpose of determining my eligibility. My previous employers may be contacted (unless otherwise noted by me on this application or in writing). I hereby release, indemnify, and hold harmless any governmental entity, employer, and person furnishing or receiving records and information about me. I further understand that if I am employed by the City of Freeport that some potential employer may in the future contact the City concerning my work record and performance at the City. I hereby consent to and authorize persons employed by the City to divulge any and all information they consider to be relevant to any person representing themselves to be an employer of mine or a potential employer of mine with respect to my work record and the performance of my job at the City of Freeport Signature of Applicant:
Date Signed Please Enter Today's Date

EEOC DATA SHEET

 

To enable the City of Freeport to meet federal government reporting regulations, applications are requested (but not required) to complete this data sheet. This information will be used solely for reporting purposes. It will not be used in any manner for screening or selection purposes for the position you have applied for. This information will be kept strictly confidential. Your voluntary cooperating in providing us with this information will be greatly appreciated.

 

Position Applied For:
Name:
Date:
Date of Birth:
Address:
County, State, & Zip:
Sex:
What is your race/ethnicity? Please Mark the one box that describes the race/ethnicity category with which you primarily identify Please Select One Box





Please check the appropriate box if any of these also applies to you, I am :

 
I hereby authorize the City of Freeport to investigate my criminal background for the purposes of evaluating my qualifications for the position for which I am applying. I understand that the City of Freeport may utilize an outside firm or firms to assist them in verifying such information, and I specifically authorize such an investigation by City of Freeport personnel and/or outside entities of the agency's choice. 

 

Name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history record information (CHRI}; therefore, the City of Freeport will not discuss with me any CHRI obtained using the name and DOB method. 

 

I also understand that if I reconsider my authorization for a criminal background check, the agency will pull my application for employment and the investigation process will cease. 

 

 
DISCLAIMER: By typing your name below you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application Signature of Applicant or Employee:
Date Signed Please enter today's date
Date of Birth Please Enter your Birth Date
You may e-mail a copy of all certifications, degrees, transcripts, and licenses as applicable to jobs@freeport.tx.us , please make sure to include your name and position applying for in the subject line.

Click here to submit your completed application, please carefully verify you have filled out all applicable information as you cannot go back after this action is done.

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