Form Center

2. 312 East Third Street
   Lampasas, TX 76550
3. Application for Employment
4. (512) 556-6831 hr@cityoflampasas.com
6. Applicant Information
8. Last Name*
9. First Name*
10. Middle Initial
12. Mailing Address*
13. City*
14. State*
15. Zip*
17. Physical Address
18. City
19. State
20. Zip
22. Cell Phone*
23. Other Phone
24. Email Address*
26. Position Information
28. Position you are applying for*
29. Date available to work*
    Date available to work
31. What type of employment are you willing to accept?
    -- Select One --Full-TimePart-TimeTemporary
32. Salary or wage requested*
34. Resume Upload
35. How did you learn of this job posting?
37. General Information
39. Are you under the age of 18?*
    -- Select One --YesNo
40. Could you verify age after employment?*
    -- Select One --YesNo
42. Are you a citizen of the U.S.A?*
    -- Select One --YesNo
43. If no, are you legally eligible to be in the U.S.A?
    -- Select One --YesNo
45. Alien registration number
46. Type of VISA
47. Expiration Date
    Expiration Date
49. Are you known by any other name?
    -- Select One --YesNo
50. If yes, by what name?
52. Have you ever worked for the City before?
    -- Select One --YesNo
53. If yes, provide department name
55. Are you related to any elected official or employee of the City?
    -- Select One --YesNo
56. If yes, provide person's name, department, and relationship
58. Education History
60. Education Type
61. Name & Location of School
62. Major
63. Diploma / Degree
65. Education Type
66. Name & Location of School
67. Major
68. Diploma / Degree
70. Education Type
71. Name & Location of School
72. Major
73. Diploma / Degree
75. Education Type
76. Name & Location of School
77. Major
78. Diploma / Degree
80. Licenses & Certifications
82. License Type
83. Issuing Agency
84. Number
85. Expiration Date
87. License Type
88. Issuing Agency
89. Number
90. Expiration Date
92. License Type
93. Issuing Agency
94. Number
95. Expiration Date
97. License Type
98. Issuing Agency
99. Number
100. Expiration Date
102. Special Skills & Qualifications
104. Summarize special skills and qualifications acquired from employment, education, or experience.
106. Military
108. Have you ever served in the U.S. Military
     -- Select One --YesNo
109. Branch of Service
110. From (date) to (date)
112. Summarize any military training, education, or experience.
114. Foreign Languages
116. Language
117. Read
     -- Select One --FluentGoodFair
118. Write
     -- Select One --FluentGoodFair
119. Speak
     -- Select One --FluentGoodFair
121. Language
122. Read
     -- Select One --FluentGoodFair
123. Write
     -- Select One --FluentGoodFair
124. Speak
     -- Select One --FluentGoodFair
126. Employment History
128. May we contact this employer?
     -- Select One --YesNo
130. Employer
131. Phone
133. Address
135. Name and Title of Supervisor
137. Date Started
138. Starting Position
139. Starting Pay
141. Date Ended
142. Ending Position
143. Ending Pay
145. Briefing describe work performed
147. Reason for leaving
151. May we contact this employer?
     -- Select One --YesNo
153. Employer
154. Phone
156. Address
158. Name and Title of Supervisor
160. Date Started
161. Starting Position
162. Starting Pay
164. Date Ended
165. Ending Position
166. Ending Pay
168. Briefing describe work performed
170. Reason for leaving
174. May we contact this employer?
     -- Select One --YesNo
176. Employer
177. Phone
179. Address
181. Name and Title of Supervisor
183. Date Started
184. Starting Position
185. Starting Pay
187. Date Ended
188. Ending Position
189. Ending Pay
191. Briefing describe work performed
193. Reason for leaving
195. References
197. Name and Occupation
198. Email
199. Phone
201. Name and Occupation
202. Email
203. Phone
205. Name and Occupation
206. Email
207. Phone
209. History
211. Have you ever been convicted of a criminal offense?
     -- Select One --YesNo
213. If yes, list the offenses. When, where, and what was the dispositon of the case.
215. Has your application for bond ever been rejected?
     -- Select One --YesNo
216. If yes, explain.
218. Agreement
220. Consent and Release for Employment with the City of Lampasas
222. I hereby apply for employment at the City of Lampasas and understand and agree that:
224. Any misrepresentation or false statement by me in connection with the application will constitute justifiable cause for cancellation of this application or separation from the company's service if employed.
226. If employed by the City of Lampasas and as a condition of my continued employment with the City of Lamapsas, I will be required to comply with the Immigration Reform and Control Act of 1986 by completing an Employment Elgibility Verification (I-9) Form and presenting documents that establish my identity and employment elgibility.
228. I may be required to sign company documents, such as Patent and Trade Secret Agreements and Business Conduct Policy Acknowledgement.
230. I authorize persons, schools, employers, organizations and agencies to provide the City of Lampasas with any of my personal background information in their possession, and I agree to disclose any information that may be required to arrive at an employment decision.
232. I release from liability all individuals and organizations who supply such information.
234. I have read and understood the above.
236. Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
238. Applicant's Electronic Signature*
240. Disclosure to Employees and Prospective Employees
242. In connection with evaluating you for employment, promotion, reassignment or retention as an employee, the City of Lampasas may obtain a report containing information regarding your prior work related injuries,claims and lawsuits, driving history, credit history and criminal history. You have the right to request information regarding the nature and scope of the investigation requested. The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You may request a summary of these rights.
244. Your electronic signature below indicates that you acknowledge and understand your rights under the Fair Credit Reporting Act.*
246. Authorization to Request and Obtain Information
248. ** If you are considered for this position, staff will contact you for your social security number and your date of birth so that a background check may be completed **
250. I, *
252. authorize the City of Lampasas to obtain a report containing information regarding my prior work related injuries, claims and lawsuits, driving history, and criminal history in connection with evaluating for employment, promotion, reassignment or retention as an employee.
254. Applicant's Name*
255. Driver's License No. / State*
257. Address*
258. City*
259. State*
260. Zip*
262. Electronic Signature*
264. DPS Computerized Criminal History (CCH) Verification
266. ** If you are considered for this position, staff will contact you for your social security number and your date of birth so that a background check may be completed **
268. I, *
270. have been notified that a computerized criminal history (CCH) verification check will be performed by accessing the Texas Department of Public Safety Secure Website and will be based on name and DOB information I supply.
272. Because the name based information is not an exact search and only fingerprint record searches represent true identification to criminal history, the organization (as listed below) conducting the criminal history check is not allowed to discuss any information obtained using this method, therefore the agency may offer the opportunity to have a fingerprint search performed to clear any misidentification based on the name search, if the search provides a criminal report I know could not be mine. For the fingerprinting process I will be required to submit a full and complete set of my fingerprints for analysis through the Texas Department of Public Safety AFIS (automated fingerprint identification system). I have been made aware that in order to complete this process I must have the correct fingerprinting (FAST) form from this agency, make an online appointment, submit a full and complete set of my fingerprints, and pay a fee of $9.95 to the fingerprinting services company, L I Enrollment Services. Once this process is completed and the agency receives the data from DPS, the information on my fingerprint criminal history record may be discussed with me.
274. (This copy must remain on file by your agency. Required for future DPS Audits)
276. Electronic Signature of Applicant or Employee*
277. Date
     Date
279. Agency Name (agency use only)
280. Agency Representative (agency use only)
282. Signature of Agency Representative (agency use only)
283. Date (agency use only)
     Date (agency use only)
Leave This Blank:


285. 1. Receive an email copy of this form.
286. Email address

     This field is not part of the form submission.

287. Submit Submit and Print

* indicates a required field