<center> <img src="/Images/FormCenter/Items/NewLogo2012(small).png"> <P> <h1>Employment Application</h1> <p> 1111 Bayou Road<p> 409/938-9202<p>La Marque, TX 77568<P>www.cityoflamarque.org<p>fax: 409-935-0401 <BR><br><h3> An Equal Opportunity Employer <br><br></h3></center> We welcome and appreciate your interest in employment with the City of La Marque. We are an equal opportunity employer. No question on this application is intended to secure information for discriminatory purposes. <br><br> Applicants are required to submit accurate, complete and truthful information in response to questions on this application, on a resume, and other information provided, including post-offer medical history information and information related to the post-offer drug test provided by the City’s designated physician. Failure to do so will be grounds for rejection of this application. Applicants must provide supplemental written information where necessary to accurately and completely respond to questions. If the applicant selected for this position is not a City employee, his/her employment history will be checked for a minimum of two previous employers, or for the past ten years, whichever is greater. If the applicant is a City employee, a review of the employee’s personnel file and a reference check of the immediate supervisor will be reviewed. <br><br> This form is part of the examination process. Before completing the application, consider the duties of the job with or without reasonable accommodation and minimum qualifications for the specific job for which you are applying. You must meet the minimum qualifications of the position to be considered. <br><br> The City of La Marque reserves the right to disqualify any application which is incomplete. This application may be completed at your convenience; however, failure to provide required documents by the published recruitment deadline may result in disqualification. All applicants are required to complete an application form prior to interviewing for a position. (Resumes will not be accepted in lieu of completing the application but may be attached.)

Employment Application

1111 Bayou Road

409/938-9202

La Marque, TX 77568

www.cityoflamarque.org

fax: 409-935-0401

An Equal Opportunity Employer

We welcome and appreciate your interest in employment with the City of La Marque. We are an equal opportunity employer. No question on this application is intended to secure information for discriminatory purposes.

Applicants are required to submit accurate, complete and truthful information in response to questions on this application, on a resume, and other information provided, including post-offer medical history information and information related to the post-offer drug test provided by the City’s designated physician. Failure to do so will be grounds for rejection of this application. Applicants must provide supplemental written information where necessary to accurately and completely respond to questions. If the applicant selected for this position is not a City employee, his/her employment history will be checked for a minimum of two previous employers, or for the past ten years, whichever is greater. If the applicant is a City employee, a review of the employee’s personnel file and a reference check of the immediate supervisor will be reviewed.

This form is part of the examination process. Before completing the application, consider the duties of the job with or without reasonable accommodation and minimum qualifications for the specific job for which you are applying. You must meet the minimum qualifications of the position to be considered.

The City of La Marque reserves the right to disqualify any application which is incomplete. This application may be completed at your convenience; however, failure to provide required documents by the published recruitment deadline may result in disqualification. All applicants are required to complete an application form prior to interviewing for a position. (Resumes will not be accepted in lieu of completing the application but may be attached.)

<center><h3>RELEASE AND AUTHORIZATION – READ CAREFULLY BEFORE SIGNING</h3></center> <BR><BR>I certify that I have made no willful misrepresentation in this application, my resume and any other documents submitted by me, nor have I withheld information in my statements and answers to questions, and I confirm that the information provided on this application and any other documents I have submitted is true, correct and complete. I am aware that the information given by me in my application may be investigated. I agree to provide supplemental information if requested by the City of La Marque’s designee. I further understand that falsification or omission of information including post-offer medical history information provided to the City’s designated physician are grounds for rejection of this application and, should I be employed, may be grounds for dismissal. I understand that if any information provided on this form or others should change between the date I submit this application and the date of any employment offer and/or hire date, that I must communicate those changes in writing to the Human Resources Manager or designee in a timely manner. I further understand that this application, resume, and any other documents attached become the property of the City of La Marque and will not be returned. I understand, voluntarily authorize, and request, without reservation, any party or agency contacted by the City of La Marque including present and prior employers to furnish requested information to support my application.

RELEASE AND AUTHORIZATION – READ CAREFULLY BEFORE SIGNING

I certify that I have made no willful misrepresentation in this application, my resume and any other documents submitted by me, nor have I withheld information in my statements and answers to questions, and I confirm that the information provided on this application and any other documents I have submitted is true, correct and complete. I am aware that the information given by me in my application may be investigated. I agree to provide supplemental information if requested by the City of La Marque’s designee. I further understand that falsification or omission of information including post-offer medical history information provided to the City’s designated physician are grounds for rejection of this application and, should I be employed, may be grounds for dismissal. I understand that if any information provided on this form or others should change between the date I submit this application and the date of any employment offer and/or hire date, that I must communicate those changes in writing to the Human Resources Manager or designee in a timely manner. I further understand that this application, resume, and any other documents attached become the property of the City of La Marque and will not be returned. I understand, voluntarily authorize, and request, without reservation, any party or agency contacted by the City of La Marque including present and prior employers to furnish requested information to support my application.

<center> <h3>NOTICE OF CONDITIONS OF EMPLOYMENT</h3> <BR><BR></center> I understand that as a condition of employment with the City of La Marque, I will be required to pass a drug test and agree to abide by the City’s Alcohol and Drug Policy. <BR><BR> I understand that providing false or incorrect information in this application may result in my termination from employment. <BR><BR> I understand the City of La Marque is an at-will employer, and that neither this application, nor any city policy, gives any employee a property of interest in a job. I understand that no employee or official of the city is authorized to change this policy, or to offer permanent employment. <BR><BR> I understand that if I am hired it will be my responsibility to read and understand the City’s Employee Handbook and any updates or changes which are approved.<BR><BR> I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment. <Br><br>I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests. <br><br>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.

NOTICE OF CONDITIONS OF EMPLOYMENT

I understand that as a condition of employment with the City of La Marque, I will be required to pass a drug test and agree to abide by the City’s Alcohol and Drug Policy.

I understand that providing false or incorrect information in this application may result in my termination from employment.

I understand the City of La Marque is an at-will employer, and that neither this application, nor any city policy, gives any employee a property of interest in a job. I understand that no employee or official of the city is authorized to change this policy, or to offer permanent employment.

I understand that if I am hired it will be my responsibility to read and understand the City’s Employee Handbook and any updates or changes which are approved.

I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

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.

<center>Failure to fully complete this form shall result in your disqualification in the applicant process, or if hired, termination. <BR><BR> To provide information on additional offenses, please add additional sheets as required. <BR><BR></center> The information sought on this form will be used solely for the purpose of assisting the City of La Marque in conducting a criminal history check. More information may be necessary to complete the investigation and failure to provide such information on request will disqualify you from further consideration for employment.<BR><BR> Your criminal record, the nature & seriousness of your crime, the number of offenses, length of time since offenses, your work record with other employers after the offenses, and the nature of the position for which you are applying will be considered by the City of La Marque. <BR><BR><BR><center> Please complete this section if you have ever been convicted of, plead guilty to, no contest to, received probation, deferred adjudication, or been placed on any form of diversion for any criminal offense (misdemeanor and/or felony) in any court other than Juvenile Court.</center>

Failure to fully complete this form shall result in your disqualification in the applicant process, or if hired, termination.

To provide information on additional offenses, please add additional sheets as required.

The information sought on this form will be used solely for the purpose of assisting the City of La Marque in conducting a criminal history check. More information may be necessary to complete the investigation and failure to provide such information on request will disqualify you from further consideration for employment.

Your criminal record, the nature & seriousness of your crime, the number of offenses, length of time since offenses, your work record with other employers after the offenses, and the nature of the position for which you are applying will be considered by the City of La Marque.


Please complete this section if you have ever been convicted of, plead guilty to, no contest to, received probation, deferred adjudication, or been placed on any form of diversion for any criminal offense (misdemeanor and/or felony) in any court other than Juvenile Court.

<h3>PLEASE NOTE:</h3>This information will be maintained separately from your application and will not be considered in the application evaluation process. Completing this form is voluntary. <BR><BR> The City of La Marque is required by the Equal Employment Opportunity Commission of the United States to collect and maintain the information requested below for EEO statistical reporting purposes. Qualified applications are considered for the City of La Marque positions, and employees are treated during their employment without regard to race, color, religion, sex, national origin, age, marital status, medical condition or handicap. Please print when completing this form. Thank you.

PLEASE NOTE:

This information will be maintained separately from your application and will not be considered in the application evaluation process. Completing this form is voluntary.

The City of La Marque is required by the Equal Employment Opportunity Commission of the United States to collect and maintain the information requested below for EEO statistical reporting purposes. Qualified applications are considered for the City of La Marque positions, and employees are treated during their employment without regard to race, color, religion, sex, national origin, age, marital status, medical condition or handicap. Please print when completing this form. Thank you.