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City of Dalhart, Texas

Online Application for Employment

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All Box's mark with * must be completed

General Information:
First Name*
Mailing Address*
Middle Name
Telephone Number*
Last Name*
Social Security number*
Position Applying for*
Have you ever been employed by the City of Dalhart?*
Have you ever been convicted, paid a fine, or been placed on probation for any offense during the last 10 years? *
If YES, list all such offenses and dates, name of court, and disposition. (do not include minor traffic violations in which you paid a fine of $30 or less)
Do you have and physical or medical impairments, disabilities? *
If YES, Please Describe:
Are you related to any member on City Council, Mayor, or any City Employee? *
If Yes, Please Describe?
List all Licenses you have and their License Numbers * (Drivers, Electrical, Plumber, Ect.)
Education
High School (Name, Address, years From-To)
Did you Graduate?
Select the Highest School year successfully completed: *
Training/Business Courses: (Courses, year from-to, Diploma/Certificates)
College/University (Name, Address, from-to, Degree)
List any Speacial Training, apprenticeship, correspondence, ect not shown in other boxes:

Employment Record:

List all employment (including military) for the past 5 years.  Begin with your present employer.

In each entry please include the following:

Employer Name, Address

Supervisor, Phone number

From when to when, Job title, Salary

Description of work, Reason for leaving

Employer 1
Employer 2
Employer 3
Employer 4
Employer 5
References:

Give names, address and telephone numbers of at least 3 reliable people who are familiar with your qualifications and characteristics, do not list relatives or past employers.

Reference 1
Reference 2
Reference 3
Emergency Contact:
Person to be notified in case of emergency *
Phone Number*
Relationship



Please Read and Sign

I Certify that I have made no willful misrepresentation in this application, nor have I withheld any information in my statements and answers to questions.  I am aware that the information given by me in my application will be investigated, with my full person, and that any misrepresentation may cause my application to be rejected.

I understand that this appointment will be held at the discretion of the department head concerned (or City Manager), subject to the approval of the City Manager, and that this application is the property of the City of Dalhart and will become a part of my confidential file if I am accepted for employment.

Signature * Electronic signature (read agreement below)
Date * MM/DD/YYYY
By clicking "I agree," you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.
Do you Agree? *

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