Alamo Area Council of Governments

 

 

 

 


Application for Employment

 

Instructions for completing the AACOG application form:

1.                  Print or type information on this form using black or blue ink only.

2.                 Complete the application in its entirety.  All blank spaces must be completed.  If a question does not apply, enter N/A.

3.                  Resumes are accepted only if they are attached to the completed application.  Please do not send resumes alone.

4.                  Mail or hand deliver application to: AACOG-Personnel Office, 8700 Tesoro Drive, Suite 700, San Antonio, TX 78217; fax to (210) 225-5937; or e-mail signed and scanned application to mail@aacog.com.

 

1.  Name:           Last                                                   First                  Middle Initial

2.  Social Security Number     

     

     

     

     

3.  Title of Position Applying for:

     

4.  Home Address:

City

State

Zip Code

     

     

     

     

5.  Home Telephone Number

6.  Employer’s Telephone Number

 

(     )        -     

(     )        -     

7.  City of Employment
E

 

8.  State

 

9.  Zip Code

 

     

  

     

10. How did you learn about this job?

 

 Place an "X" for all that apply:

01 = AACOG Web Page            

     

02= Texas Workforce Commission            

     

03 = Newspaper                         

     

04= Other                                                  

     

11.  Education:

Circle the highest grade completed  GED     9     10    11     12    Associate’s    Bachelor’s    Master’s    Ph.D.

High School Name:

     

Graduated:

Yes         No

City, State:

     

 

College/Technical School Name:

     

Field of study

     

Degree or number of sem. hrs       

City, State:

     

Year Graduated     

College/Technical School Name:

     

Field of study

     

Degree or number of sem. hrs       

City, State:

     

Year Graduated     

12.  General Skills:   Word Processing/Computer Skills - List software and years of experience:       0-1 yrs     1-2 yrs  2+ yrs

     

     

     

13.  Additional Skills:

List any other skills or aptitudes that you feel add to the overall effectiveness of this position.

     

 

Name:                                Last                                                                         First                                   Middle Initial

     

     

     

14. Language(s):

 

Language other than English in which you are fluent:      

 Read

 Write

 Speak

Language other than English in which you are fluent:              Read

 

 Read

 Write

 Speak

15.  References:

List a minimum of three references, including name, address, relationship, and telephone number.

Name

Address

Relationship

Telephone Number

     

     

     

(     )        -     

     

     

     

(     )        -     

     

     

     

(     )        -     

16.  Are you related to an AACOG employee or a member of AACOG's governing board?

                                          Yes         No     If yes, list A. Name and B. Relationship:

A.       

B.       

17.  Are you a former Workforce Solutions-Alamo employee and/or board member?

                                       Yes         No    

18.  Employment History

This section MUST BE COMPLETED in its entirety, even if you are attaching a resume.  Please furnish employment history for a minimum of 10 years.  Attach additional sheets if necessary.

 

 

 

 

 

 resume.  Additional employment information may be attached.

Current or Most Recent Employer:  ____________________________________________

     

Full Time

Part Time

Address

 

City

State

Zip Code

Telephone Number

     

     

     

     

(     )        -     

Date employed:  From

     

To

     

Job Title

Supervisor's Name

 

 

 

 

     

     

 

If currently employed, may we contact your supervisor?     Yes        No

Salary:  $

(monthly)

Duties:

     

     

     

Reason for Leaving:

     

Second Most Recent Employer:  _______________________________________________

     

Full Time

Part Time

Address

 

City

State

Zip Code

Telephone Number

     

     

     

     

(     )        -     

Date employed:  From

     

To

     

Job Title

Supervisor's Name

 

 

 

 

     

     

Salary:  $     

(monthly)

Duties:

     

     

Reason for Leaving:

     

Third Most Recent Employer: 

     

Full Time

Part Time

Address

 

City

State

Zip Code

Telephone Number

     

     

     

     

(     )        -     

Date employed:  From

     

To

     

Job Title

Supervisor's Name

 

 

 

 

     

     

Salary:  $     

Duties:

     

Reason for Leaving:

     

 

Name:                            Last                                                                 First                            Middle Initial

     

     

     

19.  Office machines: List office machines that you operate.

     

     

20.  Professional Membership Affiliation: Describe briefly membership affiliation and offices you hold now or have held in professional organizations.

     

     

21.  *Have you ever been convicted of a criminal offense?

 Yes        No

22.  Have you ever been convicted of a misdemeanor involving theft, the use or possession of drugs or controlled substances, or possession of a weapon?

 Yes        No

23.  Have you ever entered a plea of nolo contendre to a criminal charge or indictment?

 Yes        No

24.  Have you ever entered into a plea bargain in a criminal charge or indictment (including misdemeanors), resulting in probation or deferred adjudication?

 Yes        No

If you answered "Yes" to any of the above questions, give details as to the offense, sentence, and year of conviction or plea.

     

     

25.  If you possess a commercial driver’s license and are applying for a driver or temporary driver position, provide a list of each specific criminal offense or traffic violation not listed above of which you have been convicted, and each suspension, revocation, or cancellation of driving privileges that resulted from those convictions.  (Required in order to comply with Texas Transportation Code, Section 522.064.

26.  Have you smoked in the last year?

 Yes        No

If yes, do you still smoke?                            Yes        No

If no, when did you quit?      

27.  In case of emergency, notify:

Name:

     

Relationship:

     

Telephone Number:

(     )        -     

Address:

     

 

I hereby certify that the foregoing statements are true, complete, and correct.  I understand that any false statement, material omission, or misrepresentation on this application may constitute grounds for denial of employment, or may result in my dismissal if discovered after my employment.  As part of the employment process and/or from time to time during my employment with AACOG, if employed, I hereby authorize AACOG to administer and I agree to submit to a physical examination and/or fingerprinting, that will be given at AACOG's expense, and I hereby authorize the release of information gathered as a result of such examinations, to be included in my personnel file at AACOG.

In consideration of my employment with AACOG, I agree to comply with all of the rules, regulations, and policies of AACOG; I agree that my employment may be terminated any time, with or without cause, and with or without notice, at the option of either AACOG or myself; I agree and understand that my employment is for an indefinite period of time; and I further understand that no one has any authority on behalf of AACOG to enter into any agreement contrary to any of the foregoing, unless otherwise specifically stated in writing and signed by the Chairman of AACOG's Governing Board.

Signature

Date:                  

*NOTE TO APPLICANT: If for any reason you refuse to answer the foregoing questions regarding criminal history and/or refuse to execute the accompanying Consent to Background Search, no questions will be asked and no conclusions will be drawn; however, in that event, your employment application will be rejected and denied from consideration.

EQUAL OPPORTUNITY EMPLOYER

AACOG is an Equal Opportunity Employer.  Federal and State Laws prohibit discrimination in employment practices because of race, color, religion, sex, age, national origin or disability.  No question on this application is asked for the purpose of limiting or excluding any applicant's consideration for employment because of his or her race, color, religion, sex, age, national origin, or disability.  Auxiliary aids will be made available upon request.

Additional page(s) attached?   Yes     No

 

NOTICE OF BACKGROUND SEARCH AND INVESTIGATION

 

You are advised that in connection with your application for employment, Alamo Area Council of Governments and/or its agents may make an investigation of your background, references, character, past employment, consumer reports, education, and criminal history record information, which may be conducted through personal interviews or which may be obtained from any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on your application and/or obtaining other information which may be material to your qualifications for employment.

 

You are further advised that you have a right under Fair Credit Reporting Act to make a written request within a reasonable period of time for additional information regarding the nature and scope of this investigation, as well as for a written summary of your rights under the Act.  You are further advised that prior to taking any adverse action based in whole or in part on this investigation, Alamo Area council of Governments will provide you a copy of any consumer report obtained therein and a summary of your rights under the Act.

 

CONSENT TO BACKGROUND SEARCH AND INVESTIGATION

 

I, ________________________________, hereby authorize the Alamo Area Council of Governments ("AACOG") and/or its agents to make an investigation of my background, references, character, past employment, consumer reports, education, and criminal history record information, which may be conducted through personal interviews or which may be obtained from any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment.  A telephone facsimile, (fax) or xerographic copy of the consent shall be considered as valid as the original.

 

Upon a written request made within a reasonable period of time, AACOG shall provide additional information regarding the nature and scope of this investigation, as well as for a written summary of my rights under the Fair Credit Reporting Act.  Prior to taking any adverse action based in whole or in part on this investigation, AACOG shall provide to me a copy of any consumer report obtained therein and a summary of my rights under the Act.

 

I release AACOG and/or its agents and any person or entity that provides information pursuant to this authorization from any and all liabilities, claims, or lawsuits arising out of or relating to the information obtained from any and all of the above-referenced sources.

 

 

AACOG

BY

(  ) Credit (  ) Criminal (  ) Driving

NR-Date

Social Security Number

Position Applied for

     

     

Last Name

Middle Initial

First Name

     

     

     

Address

City

State

Zip

Telephone #

     

     

     

     

(     )        -     

Date of Birth

Driver's License or ID #

Commercial Driver’s License

Class

Passenger Endorsement

State

     

     

Yes  No

A  B  C

Yes  No

     

Signature

 

Date

 

 

 

                                                                                               

 

AACOG certifies that it has made all disclosures required by the Fair Credit Reporting Act to the individual identified above, that it will make any and all disclosures as may be required in the future, and that the information obtained will not be used in violation of any applicable federal or state equal employment opportunity law or regulation.

 



 Name:                          Last                                                                  First                             Middle Initial

     

     

     

28.  Employment History (continued):

 

Fourth Most Recent Employer:

     

Full Time

Part Time

Address

City

State

Zip Code

Telephone Number

     

     

     

     

(     )        -     

Date employed:  From

     

To

     

Job Title

Supervisor's Name

 

 

 

 

     

     

Salary $      monthly

Duties:

     

     

     

Reason for Leaving:     

Fifth Most Recent Employer: 

     

 

Full Time

Part Time

Address

City

State

Zip Code

Telephone Number

     

     

     

     

(     )        -     

Date employed:  From

     

To

     

Job Title

Supervisor's Name

 

 

 

 

     

     

Salary:  $      monthly

Duties:

     

     

     

Reason for Leaving:

     

Sixth Most Recent Employer:

     

   

Full Time

Part Time

Address

City

State

Zip Code

Telephone Number

     

     

     

     

(     )        -     

Date employed:  From

     

To

     

Job Title

Supervisor's Name

 

 

 

 

     

     

Salary:  $      monthly

Duties:

     

     

Reason for Leaving:

     

Seventh Most Recent Employer:

     

 

Full Time

Part Time

Address

City

State

Zip Code

Telephone Number

     

     

     

     

(     )        -     

Date employed:  From

     

To

     

Job Title

Supervisor's Name

 

 

 

 

     

     

Salary:  $      monthly

Duties:

     

     

Reason for Leaving:

     

Signature

Date:                  

 

EQUAL EMPLOYMENT OPPORTUNITY STATEMENT

 

Affirmative action is taken by Alamo Area Council of Governments to employ and advance in employment qualified individuals regardless of their race, religion, ethnic origin, sex, disability, age, or veteran status.  To assist in this effort, all applicants are requested to complete this form.  Your cooperation is strictly voluntary.  The information provided will be kept confidential, separate from personnel files, and will be used only for reporting purposes in accordance with Federal laws and regulations.

 

If you do not wish to provide this information, please print your name, the date, and indicate such fact in the appropriate space below.  Your decision in this regard will not affect your application.

 

____________________________         _______        ________      I do not wish to provide the

                       Name                             Date                          the information requested below.

 

Affirmative Action Data

 

Please check the appropriate indicator.  Are you:

 

 White                      Black                                  Asian or Pacific Islander

 

 Hispanic               American Indian      Other (Specify)_________

 

Federal regulations define a disabled person as one who has a physical or mental impairment which substantially limits one or more of that person's major life activities (a major life activity is any mental or physical function, which if impaired, creates a substantial barrier to employment), or has a record of any impairment, or is regarded as having such impairment.

 

Do you have any physical, mental, or medical impairments which would interfere with your ability to perform the job-related functions required in this particular position for which you are applying?

                                                                  

YES                                NO

 

If yes, please identify your disability and what accommodations, if any, you may need to successfully perform your work.

________________________________________________________________________________________________________________________________________________________________________

 

Do you qualify as a Veteran of the Vietnam Era?  A Vietnam Era is defined as persons who either:

 

(1)               served on active duty for a period of more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was discharged or release therefrom with other than dishonorable discharge, or

(2)               was discharged or released from active duty for a service-connected disability if any part of such active duty was performed between August 5, 1964, and May 7, 1975.

                                                             

                                                                   YES                         NO