PERSONAL DETAILS

Full Name* Home Address (Street, Apt/Unit #, City, State, Zip Code)* How many years have you lived at this address?* Phone Number* Email Address* SSN* __________________________________________________
Date Available* Which position are you applying for?* Agriculture ClerkBookkeeper Are you related to the Chief Appraiser?* YesNo Are you related to any member of the District's Board of Directors?* YesNo Employment at the appraisal district may require light to moderate physical activity, such as sitting or standing for extended periods, walking, bending, lifting, etc. Will you require any special accommodations to perform essential job functions? YesNo Are you a citizen of the United States?* YesNo Have you ever worked for this office?* YesNo Have you ever been convicted of a felony?* YesNo __________________________________________________

EDUCATION

High School* School Address Years Attended Did you graduate?* YesNo College/University/Trade School: School Address Years Attended Did you graduate? YesNo __________________________________________________

References

Please list three professional references:

Reference 1*: Full Name Relationship Company Address Phone Email
Reference 2*: Full Name Relationship Company Address Phone Email
Reference 3*: Full Name Relationship Company Address Phone Email __________________________________________________

PREVIOUS EMPLOYMENT

Company 1: Company Address Phone Job Title Supervisor How long did you work here?* Responsibilities* May we contact your previous supervisor for a reference?* YesNo
Company 2: Company Address Phone Job Title Supervisor How long did you work here? Responsibilities May we contact your previous supervisor for a reference? YesNo
Company 3: Company Address Phone Job Title Supervisor How long did you work here? Responsibilities May we contact your previous supervisor for a reference? YesNo
Have you ever been bonded?* YesNo __________________________________________________

MILITARY SERVICE

Branch Year(s) Served Rank at discharge Type of discharge Honorable DischargeGeneral Discharge under Honorable ConditionsOther than HonorableBad Conduct DischargeDishonorable DischargeMedical DischargeEntry-Level SeparationSeparation for the Convenience of the Government __________________________________________________

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

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