Real County is an Equal Opportunity Employer. Federal and State laws prohibit discrimination in employment practices on the basis of race, color, religion, sex, age, national origin, or disability. POSITION APPLIED FOR: ______________________________________________________ DATE: _________________ (Please Print) DATE AVAILABLE TO BEGIN WORK: _____________________________________ Full Time Part Time Temporary NAME: _______________________________________________________________________________________________ Last First Middle ADDRESS: ____________________________________________________________________________________________ Street or PO Box City State Zip PHONE NUMBER(s): ___________________________________________________________________________________ Do you have a high school diploma or a G.E.D? Yes No Name of High School: __________________________ College/University College/University Vocational/Technical School Name: School Address: City/State/Zip Telephone Number Semester Hrs. Completed Diplma/Degree Are you bilingual? Yes No If yes, in what language(s)? _____________________________________ OFFICE SKILLS: Word Processing Software___________________________ Spreadsheet Software ____________________ Other (Specify): ____________________________ Licenses and/or Certificates: ____________________________________ ROAD & BRIDGE POSITIONS ONLY: Front End Loader _______ Dozer _______ Grader _______ Dump Truck _______ Other Equip_____________________ Do you have a valid Commercial Driver’s License? Yes No Page 1 of 3 Rev 07/2016  Job Title: Dates Employed Job Duties/Work Performed From: To: Employer: Hourly Rate/Salary Start End Employer Employer Address: Phone: Reason for Leaving: Job Title: Dates Employed Job Duties/Work Performed From: To: Employer: Hourly Rate/Salary Start End Employer Employer Address: Phone: Reason for Leaving: Job Title: Dates Employed Job Duties/Work Performed From: To: Employer: Hourly Rate/Salary Start End Employer Employer Address: Phone: Reason for Leaving: Page 2 of 3 Rev 07/2016  Job Title: Dates Employed Job Duties/Work Performed From: To: Employer: Hourly Rate/Salary Start End Employer Employer Address: Phone: Reason for Leaving: Are you currently an employee of Real County? Yes No If yes, which department? ________________ Have you been previously employed by Real County? Yes No If yes, give date _________________ Do you have a reliable means of transportation to work? Yes No Have you ever been convicted of a felony? Yes No If yes, please explain: ___________________________ PLEASE READ THE FOLLOWING CAREFULLY AND INDICATE YOUR UNDERSTANDING AND ACCEPTANCE BY SIGNING IN THE SPACE PROVIDED I certify that the above statements are true and correct to the best of my knowledge and belief, and hereby grant Real County permission to verify such answers. I understand that any misstatement, falsification, or omission of information may be grounds for refusal to hire or, if hired, termination. I understand that Real County is an “at-will” employer. The “at-will” rule in Texas means an employer or employee may terminate an employment relationship at any time, with or without cause. I understand that as a condition of employment, I will be required to provide legal proof of authorization to work in the U.S. I understand that if I am hired by Real County, I may be required to undergo a drug test and/or a background check. I further understand that acceptance of this application by the employer does not express or imply an offer of employment. _________________________________________________ ___________________________________ Signature Date Page 3 of 3 Rev 07/2016