City of Bastrop seal. City of Bastrop.

Application for Employment
Please type in, print and mail completed form and original signature to:
City of Bastrop, P.O. Box 427, Bastrop, Texas, 78602.

Equal access to programs, services and employment is available to all persons. Those applicants requiring accommodation to the application and /or interview process should contact the Human Resources Department at 512-321-2866.
Please print or type all seven sections:
Position applied for:
Referral Source:
 
Personal Information
Name:
Address:
May we contact you at work?
   
If you are under 18, can you furnish a work permit?    
Have you filled an application here before?
Have you ever been employed here before?    
If yes, give dates:
Are you legally eligible for employment in this country?    
(Proof of U.S. citizenship or immigration status will be required upon employment.)
Type of employment desired:
 
Are you on lay-off and subject to recall? Will you relocate if your job requires it?
Will you travel if your job requires it? Are you able to meet the attendance requirements of the position?
   
 

Will you work overtime if required? Have you ever been bonded?
Have you been convicted of a felony in the last seven (7) years? (Such conviction may be relevant if job related, but does not bar you from employment.)

Employment History
List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience.
Explain any gaps in employment in the comments section below.
Employer: Address:
Telephone:
Job Title:
Immediate Supervisor
and Title: 		Reason for leaving:
May we contact for reference? Yes No Later Dates employed: From: to:
Hourly rate/salary: Starting: Final: per .
Summarize the nature of the work performed and job responsibilities:
Employer: Address:
Telephone:
Job Title:
Immediate Supervisor
and Title: 		Reason for leaving:
May we contact for reference? Yes No Later Dates employed: From: to:
Hourly rate/salary: Starting: Final: per .
   
   
   
Summarize the nature of the work performed and job responsibilities:
Employer: Address:
Telephone:
Job Title:
Immediate Supervisor
and Title: 		Reason for leaving:
May we contact for reference? Yes No Later Dates employed: From: to:
Hourly rate/salary: Starting: Final: per .
Summarize the nature of the work performed and job responsibilities:
Employer: Address:
Telephone:
Job Title:
Immediate Supervisor
and Title: 		Reason for leaving:
May we contact for reference? Yes No Later Dates employed: From: to:
Hourly rate/salary: Starting: Final: per .
Summarize the nature of the work performed and job responsibilities:
Comments: (including explanation of any gaps in employment.)
Skills and Qualifications: Summarize any special training, skills, licenses, certificates and/or characteristics of yourself
that may qualify you as being able to perform job-related functions for the position which you are applying.
Education Background (if job related)
A. List last three (3) schools attended, starting with most recent:
B. List number of years completed (per school):
1. 2. 3.
C. Indicate degrees or diplomas earned, if any, and school names:
D. Grade Point Average or Class Rank (per school):
1. 2. 3.
E. Major and minor field of study (if applicable):
Languages
List any foreign language(s) you know and check the boxes that describe your skill level.
Language 1:
Speak some Speak fluently Read Write
Language 2:
Speak some Speak fluently Read Write
Language 3:
Speak some Speak fluently Read Write
 
Language 4:
Speak some Speak fluently Read Write
References
List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
Name: Telephone: Years known:
Name: Telephone: Years known:
Name: Telephone: Years known:
List professional, trade, business, or civic associations and any offices held. (Exclude memberships which would reveal sex, race, religion, national origin, age, color, disability or other protected status.)
Organization:
Offices held:
Organization:


Offices held:
 
Organization:
Offices held:

List special accomplishments, publications, awards (exclude information which would reveal sex, race, religion, national origin, age, color, disability or other protected status.)

List any additional information you would like us to consider:

Please answer the following questions:
Are you related to any City employee or member of the Bastrop City Council?
Yes No
If yes, what is the relationship?

  • It is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed.
  • I give the employer the right to investigate all references and to secure additional information about me, if job-related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.
  • The employer is an Equal Opportunity Employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law.
  • This application is current for 2 years. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.
  • I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary.
  • I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of this person's need for an accommodation that would be required by the ADA.
  • Any applicant tentatively selected for safety sensitive positions will be required to submit to a physical and drug and alcohol screening prior to employment.


Signature of Applicant ___________________________________

Date: _______/_______/_______

 

 

 

 

 

 

 

 

City of Bastrop
At-Will Employer

I understand that nothing in this application, or in any prior or subsequent written or oral statement, creates a contract of employment or any rights in the nature of a contract. I agree and understand that if I am hired by the City of Bastrop, my employment will be at-will, for an indefinite period of time, and may be terminated at any time, with or without cause or notice, at the option of the City of Bastrop or myself. I understand that I have the right to end my employment at any time and that the City of Bastrop retains that same right. I also understand that no one has the authority to enter into any contract, agreement or modification of the foregoing unless such contract, agreement or modification is in writing and signed by the City Manager.

Applicants signature: ________________________________________

Date: _______/_______/_______


The City of Bastrop is an Equal Opportunity Employer

Notice
A hardcopy of the application with an original signature must be printed and mailed to be officially accepted for a position posting.
Saving this web page will not save your entries.

Affirmative Action Voluntary Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Affirmative Action Voluntary Information

(Completion of information below is voluntary)

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected status.
To be completed by applicant. Not for interview purposes. To be filed separately from application. This information is used to satisfy the Affirmative Action requirements of Section 503 of the Rehabilitation Act or as necessitated by another federal law or regulation.

As required, we comply with government regulations including Affirmative Action obligations where they apply.
In an effort to comply with requirements regarding government recordkeeping, reporting and other legal obligations, we ask that you complete this applicant data survey. Your cooperation is appreciated.
Please be advised that this survey is not a part of your official application for employment. It is considered confidential information that will not be used in any hiring decision.
Position(s) applied for: date:
Referral Source:
 Government Employment Agency Walk-in Relative
Employee Private Employment Agency School Other
Advertisement - Source:
 Name of person who referred you (if applicable):
Applicant Information:

Name: Last: First: Middle:

Telephone and area code:
Address: Street: City: State:
Zip Code:    
Gender: male female    
Please check one of the following Equal Employment Opportunity Identification Groups:
White Black (not of Hispanic origin) American Indian/Alaskan Native
Hispanic Asian/Pacific Islander  

Special Notice

To Vietnam Era Veterans, Disabled Veterans and Individuals with physical and mental disabilities:

Government contractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veterans, veterans of the Vietnam era and qualified handicapped individuals.

You are invited to volunteer this information, if you qualify, to assist in proper placement and determining reasonable accommodation. This information will be considered confidential. Refusal to provide this information will not adversely affect your consideration for employment.

If you so wish to be identified, please check if any of the following are applicable:

Vietnam era Veteran (served between 1964 - 1975)
Disabled Veteran
Individual with a disability

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