HARRISON COUNTY FAX 200 APPLICATION
User Manual: FAX-200
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HARRISON COUNTY (903)923-4018-OFFICE
Human Resources Dept. (903) 935-4800-FAX
200 W. Houston, Room 328 www.harrisoncountytexas.org
Marshall, TX 75670
velmam@co.harrison.tx.us
APPLICATION FOR EMPLOYMENT
___________________________________________________________________
PLEASE READ THESE INSTRUCTIONS PRIOR TO COMPLETING THIS APPLICATION
1. Thank you for your interest in employment opportunities with Harrison County. Applications are
accepted for posted positions only. You are welcome to apply for more than one position; however,
YOU MUST COMPLETE A SEPARATE APPLICATION FOR EACH POSITION YOU WISH
TO APPLY FOR. Applications are valid for the duration of each announcement.
2. Please complete this application in type or neat, legible print (using black or blue ink). A resume and
/or other documents will not be accepted in lieu of a completed application; however, you may submit
additional documents with the application.
3. The information you provide on this application should clearly reflect your suitability to the position
you are applying for. Your employment record, position-related educational requirements, skills,
knowledge, abilities, qualifications, and experience will be evaluated based upon the information you
provide in this application. Your application will be referred to the hiring department only if the
minimum requirements as described in the Job Vacancy Notice are met. If you are selected for an
interview, you will be contacted by the Human Resources Department.
4. In order for your application to be considered complete, you must answer all questions in this
application. AN INCOMPLETE APPLICATION WILL NOT BE CONSIDERED. Any
information that you provide in this application, accompanying documents, and/or give verbally to
Harrison County is subject to verification. Falsification, misrepresentation, or omissions of fact may be
grounds for rejection of your application, or subsequent termination of employment if hired. A
comprehensive pre-employment reference and background screening will be conducted on all
applicants as permitted by law. Comments such as “See Resume” are not acceptable and may
result in the application being considered incomplete.
5. Harrison County promotes a drug-free work environment and may require all applicants who receive a
conditional offer of employment to successfully complete a drug screening test. A physical
examination, Agility testing, driving record, and/or criminal history check may also be required after a
conditional offer has been extended.
6. This application and any accompanying document(s) submitted for consideration of employment
become property of Harrison County and will not be returned to the applicant.
7. This application becomes public record and is subject to disclosure in accordance with the Texas
Government Code Ann. § 552-Public Information Act.
_________________________________________________________________________________
Harrison County is an EQUAL OPPORTUNTIY employer
Promoting DIVERSITY And a DRUG-FREE work environment
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Human Resources Department
Harrison County Courthouse
200 W. Houston, Room 328
Marshall, TX 75670
(903) 923-4018
velmam@co.harrison.tx.us
Harrison County Fax: (903) 935-4800
Employment Harrison County Website:
Application www.harrisoncountytexas.org
An Equal Opportunity Employer
It is the policy of Harrison County not to discriminate in employment on the basis of race, religion, color, age, national origin, sex,
marital status, veteran status or disability. To request a reasonable accommodation or other assistance, contact the Human Resources
Department at (903) 923-4018, or mail your request to the address above.
Name ___________________________________________________________________________ Date ____________________
(Last) (First) (Middle)
Address ___________________________________________________________________________________________________
(Street) (City) (State) (Zip)
Telephone ______________________ Cell Number ___________________ Social Security No.__________________________
(Home)
Position Applied For _______________________________________________ Department _______________________________
Are you willing to work: Full-time Part-time Temporary Shift work
May we contact your present employer: Yes No
__________________________________________________________________________________________________________
PREVIOUS EMPLOYMENT: List all employment (including military service) for at least the past 10 years. Begin with your
present position and work back. Attach additional sheets or resume to provide sufficient qualifying experience data. Be thorough
since your answers may determine whether or not you will be considered for a position. The “Reason for Leaving” and “Salary” must
be completed. (Attach additional sheets if needed). Any applicant providing unrequested information might be rejected.
(1) Present or Last Employer Phone No.
Address Date started Date Left
Supervisor Your Title Salary
Description of Work
Reason for Leaving/Wanting to Leave
(2) Previous Employer Phone No.
Address Date started Date Left
Supervisor Your Title Salary
Description of Work
Reason for Leaving/Wanting to Leave
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(3) Previous Employer Phone No.
Address Date started Date Left
Supervisor Your title Salary
Description of Work
Reason for Leaving/Wanting to Leave
(4) Previous Employer Phone No.
Address Date started Date Left
Supervisor Your Title Salary
Description of Work
Reason for Leaving/Wanting to Leave
Please explain all periods of unemployment exceeding 90 days:______________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
EDUCATION:
Did you graduate from high school? Yes No if no, last grade completed ______ GED Obtained? Yes No
College-University-Trade
Business-Correspondence School
Name Location
No. Of
Years
Major Area
Of Study
Semester
Hours
Degrees
Granted
(Applicants may be required to provide copies of transcripts and/or diplomas/certificates)
Military Service of the United States:
Branch of Service _______________________________ List any relevant job-related skills during military
service (you may be required to provide a copy of form DD214)._____________________________________
Personal Data:
Please list any other names you have used in connection with employment or education__________________
________________________________________________________________________________________
Have you previously worked for Harrison County? Yes No If so, when?_________________________
Department __________________Position _____________________Supervisor _______________________
Are you authorized to work in this country? Yes No (Proof of citizenship or immigration status will be required
upon employment)
Do you use any Tobacco Products: Yes No Are you at least 18 years of age: Yes No
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Can you perform the essential functions of the job for which you are applying with or without reasonable
accommodation? Yes No
Are you currently under indictment for any crime? Yes No If yes, state nature of indictment, date, and
location of case(s)._______________________________________________________________________
Have you ever: been convicted, pled guilty, pled no contest, or received deferred adjudication or probation for
and criminal act?*
Yes No *A criminal conviction is not necessarily a bar to employment. False statements or omissions
of information, whether intentional or unintentional, will be grounds for immediate elimination from further
consideration (or dismissal from employment with Harrison County if hired.)
If yes, list ALL such offenses and state date, name of Court and disposition. (You may omit minor traffic violations for
which you paid a fine of $100 or less)
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
List all counties and states you have resided in within the past 10 years.
_________________________________________________________________________________________
Do you have a current driver’s license? Yes No
Do you have a commercial driver’s license? Yes No
Has your driver’s license ever been suspended or revoked: Yes No
If yes, explain:_________________________________________________________________________
List all licenses/certifications/registrations you hold (such as Drivers, electrician, etc.)
Type ______________________________ Number ______________________Expiration Date____________
Type ______________________________ Number ______________________ Expiration Date____________
_________________________________________________________________________________________
Are you related by blood or marriage to any Harrison County employee/official? Yes No
_________________________________________________________________________________________
Name Where Employed Relationship
Give the names and addresses of three persons, other than relatives, who have knowledge of your
character, experience or ability:
Name
Address
Occupation
Telephone Number
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List any additional experience and training you have had which in your opinion would qualify you for the
position you seek:
(Example: apprenticeships, technical skills, foreign languages spoken/written, etc) _______________________
__________________________________________________________________________________________
__________________________________________________________________________________________
If employed, I understand that Harrison County may elect to pay compensation or cash overtime as allowed
under Fair Labor Standards Act.
IMPORTANT
It is the responsibility of the applicant to read the following before signing:
I certify that the answers given herein are true and complete. I understand that any falsification or willful
omission made in my application, resume or interview(s) shall be sufficient cause for dismissal or refusal of
employment, whenever discovered. I understand that the information provided in my application, resume and
interviews may be investigated, and I hereby authorize each former employer, whether given as a reference or
not, to answer any questions and furnish any information sought by the County concerning any qualifications
for employment. Depending on the department and position applied for, I understand that such investigation
may include a full criminal history and FBI records check. I hereby release the County and all third parties
supplying information to the County from all liability, including liability caused by negligence, arising from
reference and background checks conducted by or on behalf of the employer about me. I also understand that
this application is subject to the Open Records Act and may be released as a public document.
I understand that my employment is at the discretion of the Commissioners’ Court or elected Department Head
concerned, and that Harrison County is an employment-at-will employer, which means that I may resign at any
time and the County may terminate my employment at any time for any or no reason.
I understand that my employment is contingent upon successful completion of a conditional post-employment
offer fitness for duty examination, which will (depending on position) include a drug screen. Health care
providers of the County’s selection will conduct this examination. I certify that I will fully and truthfully
answer any questions asked by the health care providers or staff. I understand that a positive result from the
drug screen will eliminate me from consideration from any County job for one year. While employed, if my
department head requests, I will submit to additional physical examinations by health care providers of the
County’s selection for the purpose of determining my fitness for continued employment. If injured during the
course of employment, I will promptly report such injury to my supervisor or department head. If medical
treatment is necessary or requested, I will submit to treatment or examination by health care providers of my
selection.
I understand that some departments of the County have an Employee Handbook or policies, which describe
additional obligations, terms and conditions of employment. I agree to promptly familiarize myself with the
terms of such documents and abide thereby, if applicable. I understand and agree that all benefits, programs,
rules and policies of the County are subject to exceptions or change at any time, as decided by the County.
I certify that I have carefully read each provision of this application for employment and that I have been given
an opportunity to ask questions concerning any provision, which I do not fully understand.
This application must be signed.
Signature____________________________________________ Date _______________________________
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Please indicate your experience/skills/abilities in the following areas:
Typing Speed: Skills: Clerical Experience: No. Of Years
Below 40 wpm 10-Key by touch Receptionist __________
40-49 wpm Excel Data Entry __________
50-59 wpm Word Bookkeeping __________
60-69 wpm Word Perfect Filing __________
Above 70 wpm Power Point Purchasing __________
Other word processing ______________ Secretarial __________
Other Software _____________________ Records Management __________
Quattro Pro Cashier __________
AS/400 Mainframe Other___________________________
Shorthand – speed ________________ _______________________________
Court Reporting __________________________________
Other: _________________________ __________________________________
______________________________ __________________________________
LABOR/MAINTENANCE/SKILLED CRAFT/EQUIPMENT OPERATION
Please indicate your experience/skills/abilities in the following areas:
Skill Areas No. Of Years Exp. Equipment Operated No. Of Years Exp.
Concrete finishing ______________ Water Truck ______________
Welding ______________ Chip Spreader ______________
Asphalt work ______________ Backhoe ______________
Surveying ______________ Front End Loader ______________
Setting grades ______________ Bulldozer ______________
Flagging ______________ Track hoe ______________
Plumbing ______________ Tractor Trailer ______________
Painting ______________ Tractor with mower ______________
Carpentry ______________ Hydraulic excavator ______________
Electrical ______________ Motor grader ______________
HVAC ______________ Dump truck ______________
Auto mechanic ______________ Winch truck ______________
Heavy equip. Mechanic ______________ Roller-packer ______________
Sign maintenance ______________ Pneumatic roller ______________
Grounds keeping/landscaping ______________ Other_______________ ______________
Road maintenance/construction ______________ _____________________ ______________
Other_____________________ ______________ _____________________ ______________
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Harrison County is an Equal Opportunity Employer. We request that you provide the following information,
which is used to study recruitment and employment patterns and to provide statistical data to federal compliance
agencies. This information will be kept separate from your application and kept confidential and will in no way
be used in consideration of your application for employment. Completion of this portion of the form is
voluntary. Failure to provide this information will not jeopardize your opportunity for employment with
Harrison County.
Check the most appropriate blank:
Male White American Indian
Female Black Asian
Hispanic Other
If “Other”, please specify: ___________________________________________________________
What led you to apply with the County:
Stopped in to check on available jobs Texas Work Force Commission
Referred by a County employee Newspaper
Other (please list) ______________________________ Harrison County Website
Revised 2/25/2008
Revised 1/7/2014
