Randall County Employment Application - Amarillo, Texas · 2017-10-25 · Randall County Employment...

Randall County Employment Application

An Equal Opportunity Employer

Human Resources Office 501 16th Street, Suite 302 (806) 477‐1701 Canyon, Texas 79015 RandallCountyHR‐Payroll @randallcounty.org

Position Sought: _______________________________________________________________________

Is this a driving position? Yes: ____ No: ____ If yes, complete Authorization to Check Driving Record.

Name: _______________________________________________________________________________ Last First Middle Initial Maiden

Address: _____________________________________________________________________________ Street City State Zip Code

Email Address: ___________________________________ Telephone: ______________________ Please circle one: Home Phone / Cell

Have you previously worked for Randall County? Yes: _____ No: _____ If yes, when: ______________

What type of employment will you accept? Full‐time: ______ Part‐Time: ______ Temporary: ______

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: _______________________________

Dates of employment: _______________________ Last Rate of Pay: _________________________

Position: __________________________________ Immediate Supervisor: ____________________

Description of Work: _________________________ Reason for Leaving: ______________________

Who may we contact as a reference? ____________________________________________________ Name Position Phone Number










Who may we contact as a reference? ____________________________________________________ Name Position Phone Number If you need additional lines, please ask Human Resources for additional Employment History pages.

Have you ever been involuntarily terminated from a position of employment? If so, please explain. (This question does not apply to a layoff or reduction in force for economic reasons). ____________________ ________________________________________________________________________________

MILITARY SERVICE:

Branch of Service: ______________________________ Dates of Service: ________________________

EDUCATION:

Did you graduate from high school? Yes: ____ No: ____ If not, do you have a GED? Yes: ____ No: ____

Please indicate all college degrees and/or applicable coursework:

School Name Area of Study Degree Received/Semester Hours ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

Please list all licenses and certifications you hold which you believe qualify you for the position you seek:

Type: _____________________________ Number: ________________ Expiration: _______________

Type: _____________________________ Number: ________________ Expiration: _______________ 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: ______________________________________________ _______________________________________________________________________________ ___________________________________________________________________________________

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.

________________________________________________________________________________ Applicant’s Signature Date

Randall County Authorization to Check

Driving Record


I, __________________________________, applicant for the __________________________________ position with Randall County, do hereby authorize Randall County to obtain a copy of my driving record to be used to evaluate my potential and/or continued employment with Randall County. I hereby authorize the Texas Department of Public Safety or any other entity authorized to access state or federal agency records to furnish Randall County, or its agent, my driving record. I do hereby release all agents, servants, and employees of Randall County, from all liability resulting from the release of this information. ____________________________________ _______________________________________ Driver’s License Number State of Issuance _______________________________________ _______________________________________ Driver’s License Number State of Issuance _______________________________________ _______________________________________ Driver’s License Number State of Issuance ACKNOWELDGED AND AGREED: _______________________________________ _______________________________________ Signature Date _______________________________________ _____________________________________ Printed Name Date of Birth

Randall County Employment Application

An Equal Opportunity Employer


ADDITIONAL EMPLOYMENT HISTORY (IF NEEDED)

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.





















RANDALL COUNTY SHERIFF’S OFFICE

PRE –EMPLOYMENT SCREENING CHECKLISTFOR ALL POSITIONS

Name: _______________________________

Date: __________________________________

Instructions for Completing thePre-Employment Screening Checklist

It is important that you answer all questions completely and honestly. This isNOT a test, but rather a checklist covering the minimum qualifications forcontinuation in the hiring process with the Randall County Sheriff’s Office. Aspart of the checklist process, you will be required to furnish specificdocumentation at a requested time.

Any false statement or omission of information regarding any subjectin this questionnaire may result in the rejection of your checklist.

Revised 12/17/2013

The Pre-Employment Screening Checklist may be completed in the applicant’sown handwriting or typed. Use black ink and print legibly.

Checklist with unanswered questions will not be accepted. If you do notunderstand any of the questions, contact the Lt. Dennis Rice at the RandallCounty Sheriff’s Office, 806-468-5800 for clarification.

The Pre-Employment Screening checklist may be mailed in, hand delivered, orbrought by the applicant on the day of testing. The Pre-Employment Screeningchecklist will be date and time stamped upon receipt. Normal hours of operationare Monday through Friday, 8:00 AM to 5:00 PM. The telephone number is(806) 468-5800 or email [email protected]. If you are mailing yourchecklist, address it to:

Randall County Sheriff’s OfficePersonnel Section

9100 S. Georgia StreetAmarillo, TX, 79118

The Randall County Sheriff’s Office is an Equal Opportunity Employer andcomplies with the Americans with Disabilities Act. Reasonable accommodationswill be provided upon request.

mailto:[email protected]

Pre-Employment Screening Checklist

Applicant: ______________________________________________________(Last Name) (First Name) (Full Middle Name)

Other Names: ___________________________________________________ (Aliases, Maiden Names, Nicknames, etc.)

Birth Date: _____________ Age: _______Ethnicity: _________Sex: _______

Social Security #: _______-______-_______

Driver’s License and/or ID Card #: ______________________ State: _______

Physical Address: _________________________________________________

City, State, Zip Code: ______________________________________________

Mailing Address: ____________________________________________

Home Phone #: (____)_____________ Work Phone #: (____)_____________

Cell #: (____)____________ Email Address: ___________________________

Position(s) you are applying for: _____________________________________________________________________________________________________

Have you ever applied with the Randall County Sheriff’s Office? Yes NoIf yes, when? _____________________________________________________

How were you referred to the Randall County Sheriff’s Office?

RCSO Employee Employee Name:_____________________ Newspaper Radio Television Internet Site Job Fair Other Walk-in Texas Workforce Commission

Please specify which Newspaper, Internet Site, Job Fair, Radio Station, TV Station, or Other: ___________________________________________________________________________________________

The applicant is responsible for responding truthfully to each question. Falsifying or omitting information will be grounds for rejection of this Pre-Employment Screening checklist, and may be grounds for future dismissal from the Department. False or misleading statements are also subject to prosecution under Chapter 37, Perjury and Other Falsification, of the Texas Penal Code:

1. Are you a citizen of the United States of America? Yes No

2. If not, do you have an INS card or a work visa? Yes No

3. Do you have a high school diploma or GED? Yes No

4. Do you have a Bachelor’s degree or higher? Yes No

5. Do you have a valid and current driver’s license? Yes No

6. Have you ever been questioned, detained, or arrested by police or had criminal charges filed against you or been summoned to court? (This includes sealed records, Order of Restricted Access and field release citations other than for traffic offenses) Yes No

If Yes, state the reason and date: _____________________________________________

7. Have you ever been or currently on court-ordered community supervision or probation forany offense above the grade of Class B misdemeanor i.e.: Class A misdemeanor or a Felony? Yes No


8. Have you ever been convicted of an offense above the grade of a Class B misdemeanor i.e.: Class A misdemeanor or a Felony? Yes No


9. Have you ever been convicted of any Family violence offense(s)? Yes No


10. Have you been discharged from any military service under less than honorable conditions including: under other than honorable conditions, bad conduct, dishonorable, or any othercharacterization of service indicating bad character? Yes No

If Yes, identify the reason for the discharge: ____________________________________

11. Have you had a law enforcement license revoked or denied by final order, or have you voluntarily surrendered your license to avoid suspension? Yes No


12. Have you ever bought, furnished or sold any controlled substance or dangerous drug, including marijuana, to another? Yes No

If Yes, state the date: ______________________________________________________

13. Are you known to habitually associate with those of questionable moral character? Yes No


14. Are you currently or have you ever been a member of an organization which advocates the overthrow of the United States government or any governmental entity in the United States? Yes No

If Yes, state the organization and date: ________________________________________

15. Have you ever been discharged from any city, state, federal, or private corrections institute or law enforcement agency as an Officer or Civilian for disciplinary reasons, resigning to avoid suspension or discharge or having resigned during a disciplinary investigation without final judgement being rendered. Yes No

If Yes, provide an explanation on the back of this page or insert a separate page.

16. Have you made false statements, falsely sworn to statements or, in any manner, falsified testimony in any official matter or in any significant business transaction? Yes No


17. Have you ever been or currently on court-ordered community supervision or probation fora Class B misdemeanor? Yes No


18. Have you ever been convicted of a Class B misdemeanor? Yes No


19. Have you been convicted of five or more moving traffic violations and/or negligent collisions within a 24-month period during the five preceding years Yes No

20. Have you ever had a driver’s license suspended, revoked or invalid? Yes No

If Yes, state the reason and date: ____________________________________________

21. Have you ever been convicted of a Class C Misdemeanor other than Class C traffic relatedoffenses? Yes No


22. Have you used any illegal controlled substance, dangerous drug, or marijuana? Yes No

If Yes, state the illegal substance and date: _____________________________________

The Pre-Employment Screening Checklist is used to determine if an applicantmeets minimum standards for continuation in the hiring process with the RandallCounty Sheriff’s Office. RCSO hires for both civilian and officer positions;therefore some questions may not be applicable to all applicants. However, allapplicants are required to answer all questions, regardless of applicability. Oncethe Pre-Employment Screening Checklist has been reviewed and it has beendetermined that an applicant meets minimum standards, the applicant will bescheduled for the next phase of the hiring process.

After completion and return of the Pre-Employment Screening Checklist, you arerequired to keep the personnel office informed of any changes (address, phonenumbers, checklists with other police departments, jobs, etc.) Failure to do socould result in your disqualification.

I affirm that the answers and written explanations I have made to each inquiry inthis official document are true to the best of my knowledge and belief. I alsoacknowledge by my signature below that any falsification, misrepresentation, oromission of any information may be just cause for the rejection of my checklist or,if hired, used as a basis for my dismissal from the Randall County Sheriff’s Office.

I also acknowledge by my signature below that falsification, misrepresentation,or omission in this checklist could be violations of the Texas Penal Code, Chapter37 – “Perjury and other Falsification”.

_______________________________________________ _________________________Signature of Applicant Date

Randall County Sheriff’s Office 9100 S. Georgia, Amarillo, Tx 79118

806-468-5800, Fax 806-468-5768 Dear Applicant: Thank you for your interest in the Randall County Sheriff's Department. The next step in the hire process is the testing. Along with other applicants, you will be given a basic knowledge test, an oral interview, and a physical agility test. After successfully completing this testing phase, you will be set up with an individual interview and background investigations will be done. The physical agility test, listed below, must be successfully completed in order for an applicant to be considered for the position of Corrections Officer. Items 1-11 are a timed obstacle course from which applicants receive an overall score after completing.

1. Move 80 lb. dummy about 50 feet. 2. Run through sets of tires. 3. Jump a three foot wall. 4. Run a zigzag course between barrels. 7. Crawl through a tunnel. 8. Walk a balance beam. 9. Climb wall to a platform, descend stairs, climb same stairs, descend stairs once

more while carrying 45-pound weight. 10. Drag a 100 pound sled 25 feet and then stop and while standing, pull the sled

another 25 feet towards you with a rope. 11. Run one fourth of a mile. 12. Run 40 yards in less than nine seconds starting from prone position.

Can you safely complete the required test with or without reasonable accommodations? Yes No I understand I must successfully complete the physical agility test to be considered further for the position of deputy sheriff or corrections officer. I also understand that if I require reasonable accommodations to complete any part of the test, I must notify the Randall County Sheriff's Department at 9100 S. Georgia, Amarillo, TX, 79118, 806-468-5800 at least 48 hours prior to the scheduled test. The form, on the reverse side, must be completed and returned to the test location on the scheduled date. (over) ►

Revised 2/26/08 Randall County Sheriff's Department Personnel Department 9100 S. Georgia Amarillo, Tx 79118 Name_____________________________________________________________ Address__________________________________________________________ City_____________________________________Zip_____________________ Phone (Home)_____________________________Work_____________________ I am voluntarily participating in this physical agility test, and I hold harmless Randall County for any accident or injury which might occur in this pre-employment physical agility test. I certify that I presently meet all of the requirements of the Randall County Sheriff's Department (except the examinations which will be conducted). Signature_________________________________________Date___________ SWORN before me this _______day of__________________________,20 _______ ________________________ Notary Printed Name ________________________ Notary Signature Notary Public in and for_______________________ County, Texas My Commission Expires

JJooeell WW.. RRiicchhaarrddssoonn RANDALL COUNTY SHERIFF

AUTHORITY FOR RELEASE OF INFORMATION

LAST NAME___________________ FIRST NAME__________________ MIDDLE NAME ___________________

PLACE OF BIRTH_____________________ STATE_____________________ COUNTRY____________________ DATE OF BIRTH___________________ SEX________ RACE_______________ SS#________________________ I, ____________________________ , do hereby authorize a review of and full disclosure of all records, or any part thereof, concerning myself; by and to ANY duly authorized agent of the Randall County Sheriff's Office, whether the said records are of public, private or confidential nature. I authorize the Randall County Sheriff’s Office to act as my agent in obtaining any personnel information maintained by your organization. The intent of this authorization is to give my consent for full and complete disclosure of the records of educational institution; records of the Social Security Administration; financial or credit institutions, including records of deposits, withdrawals and balances of checking and savings accounts, and loans, and also records of commercial or retail credit agencies (including credit reports and/or ratings); public utility companies; employment and pre-employment records, including background reports, efficiency ratings, complaints or grievances filed by or against me, and salary records; real and personal property tax statements and records , and other financial statements and records wherever filed; records of complaint, arrest, trial and/or convictions for alleged or actual violations of law, including criminal, civil and/or traffic records; the results of any polygraph examinations; records of complaint of a civil nature made by or against me, where ever located, and to include the records and recollections of attorneys at law, or of other counsel, whether representing me or another person in any case in which I presently have, or have had an interest. I reiterate, and emphasize that the intent of this authorization is to provide full and free access to the background and history of my personal life, for the specific purpose of pursuing a background investigation that may provide pertinent data for the Randall County Sheriff's Office to consider in determining my suitability for employment by that department. It is my specific intent to provide access to personal information, however personal or confidential it may appear to be, and the source of information specifically identified herein. I understand that any information obtained by a personal history background investigation that is developed directly or indirectly, in whole or in part, upon this release authorization will be considered in determining my suitability for employment by the Randall County Sheriff's Office. I understand that all materials pertaining to this background investigation become the property of the Randall County Sheriff’s Office and will not be returned to me. I agree to indemnify and hold harmless the person to whom this request is presented and his agents and employees, from and against all claims, damage, loss and expenses, including reasonable attorney's fees, arising out of or by reason of complying with this request. I further understand that in the event my application is disapproved, the sources of confidential information cannot be revealed to me. A photocopy of this release form will be valid as an original hereof; even though the said photocopy does not contain an original writing of my signature. _________________________ __________________________ ______________________________ Signature Street Address City State Zip MUST BE SIGNED IN THE PRESENCE OF A NOTARY: Subscribed and sworn before me this______ day of_________________ 20____ My commission expires _____________________ 20___ Notary:____________________________________

SHERIFF’S OFFICE 9100 S. GEORGIA

AMARILLO, TEXAS 79118 (806) 468-5800

FAX (806) 468-5762

CIVIL DIVISION AMARILLO ANNEX

4111 S. GEORGIA, SUITE 200AMARILLO, TEXAS 79110

(806) 468-5652 FAX (806) 468-5653

Randall County Employment Application - Amarillo, Texas · 2017-10-25 · Randall County Employment...

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