AACOG Employment Application

AACOG Intern Application ( Paid Unpaid)

AACOG Payroll Service Application

AACOG Temporary Employee Application

AACOG Volunteer Application

Job Application

Personal Information

Please fill in the following basic information.

Social Security Number (Optional):
First/Given Name:
Middle Name:
Last/Family Name:
Address:
Address 2:
Address 3:
City/State/Zip:
Country:	United States of America
Work Phone:
Home Phone:
Mobile Phone:
Company E-Mail:
Personal E-Mail:

Position Information

Each position that you apply for requires a separate application.

Title of Position Applying for:

Available Start Date?

How did you learn about this position?

AACOG Website (www.aacog.com)

Work In Texas Website (www.workintexas.com)
Newspaper Ad
Job Fair

Workforce Solutions – Alamo Center Referral
Other – Please Specify _______________

Skills

Enter Word Processing, Computer or other skills and aptitudes you feel add to the overall effectiveness of this position.

Skill:
Years of Experience:
Skill:
Years of Experience:
Skill:
Years of Experience:
Skill:
Years of Experience:
Skill:
Years of Experience:
Skill:
Years of Experience:

Certifications and Licenses

Enter information about certifications and licenses that you have received below.

Certification or License:
Issued By:
Achieved Date:
Expiration Date:
Certification Number:
Comments:
Certification or License:
Issued By:
Achieved Date:
Expiration Date:
Certification Number:
Comments:

Language Abilities

Please list languages other than English in which you are fluent.

Language:
Acquired Date:
Read Proficiency Level:	Low Fair Adequate Proficient Fluent
Speak Proficiency Level:	Low Fair Adequate Proficient Fluent
Write Proficiency Level:	Low Fair Adequate Proficient Fluent
Translate Proficiency Level:	Low Fair Adequate Proficient Fluent

Language:
Acquired Date:
Read Proficiency Level:	Low Fair Adequate Proficient Fluent
Speak Proficiency Level:	Low Fair Adequate Proficient Fluent
Write Proficiency Level:	Low Fair Adequate Proficient Fluent
Translate Proficiency Level:	Low Fair Adequate Proficient Fluent

Language:
Acquired Date:
Read Proficiency Level:	Low Fair Adequate Proficient Fluent
Speak Proficiency Level:	Low Fair Adequate Proficient Fluent
Write Proficiency Level:	Low Fair Adequate Proficient Fluent
Translate Proficiency Level:	Low Fair Adequate Proficient Fluent

Education History

Enter information about your formal education history below (Post High School or GED).

Highest Grade Completed:

9 10 11 12 GED
Associate’s Bachelor’s Master’s Ph.D.

College/Technical School Name:
City/State:
Start Date/End Date:	to
Degree:
Major:
Graduated:	Yes No

College/Technical School Name:
City/State:
Start Date/End Date:	to
Degree:
Major:
Graduated:	Yes No

College/Technical School Name:
City/State:
Start Date/End Date:	to
Degree:
Major:
Graduated:

Work History

Enter information about your work history for the last 10 years.

Employment Start Date/End Date:	to
Job Title:
Company:
Address:
City, State, Zip Code
Phone Number:
Starting Pay: Indicate per hour/bi-weekly/per year, etc.	per
Ending Pay: Indicate per hour/bi-weekly/per year, etc.	per
Departure Reason:
Eligible for Rehire:	Yes No
Primary Responsibilities:

Employment Start Date/End Date:	to
Job Title:
Company:
Address:
City, State, Zip Code
Phone Number:
Starting Pay: Indicate per hour/bi-weekly/per year, etc.	per
Ending Pay: Indicate per hour/bi-weekly/per year, etc.	per
Departure Reason:
Eligible for Rehire:	Yes No
Primary Responsibilities:


Employment Start Date/End Date:	to
Job Title:
Company:
Address:
City, State, Zip Code
Phone Number:
Starting Pay: Indicate per hour/bi-weekly/per year, etc.	per
Ending Pay: Indicate per hour/bi-weekly/per year, etc.	per
Departure Reason:
Eligible for Rehire:	Yes No
Primary Responsibilities:

Employment Start Date/End Date:	to
Job Title:
Company:
Address:
City, State, Zip Code
Phone Number:
Starting Pay: Indicate per hour/bi-weekly/per year, etc.	per
Ending Pay: Indicate per hour/bi-weekly/per year, etc.	per
Departure Reason:
Eligible for Rehire:	Yes No
Primary Responsibilities:

Voluntary Information for Affirmative Action

This information is confidential and will be maintained separately from the application. Disclosure of the information is voluntary.

Gender:
Ethnic Group:
If other Ethnic Group, please specify:

Required Work Eligibility Information

Please complete all questions in this section.

Are you a prior employee of AACOG or affiliate?		Yes No
Are you related to an AACOG Board member or employee?		Yes No
If yes, please indicate name and relationship.
Former Workforce Solutions-Alamo or Alamo WorkSource employee and/or board member?		Yes No
Are you over 18 years of age?		Yes No
Can you furnish proof of eligibility to work in the United States?		Yes No
Have you ever been convicted of any criminal offense?		Yes No
Comments:
Have you smoked in the past year?		Yes No
If yes, do you smoke more than once a week?		Yes No
If you quit smoking in the past year, when did you quit?
Have you ever been discharged or asked to resign?		Yes No
Comments:

References

Professional Reference:	Yes No
Salutation:
Name:
Title:
Company:
Day Phone Number:
E-Mail Address:
Professional Reference:	Yes No
Salutation:
Name:
Title:
Company:
Day Phone Number:
E-Mail Address:

Professional Reference:	Yes No
Salutation:
Name:
Title:
Company:
Day Phone Number:
E-Mail Address:

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. I acknowledge that I am authorizing AACOG and/or its agent(s) to contact my previous employer(s).

If currently employed may we contact your employer? Yes No

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.

By submitting this application, 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 at 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 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.

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.

NOTICE OF BACKGROUND SEARCH AND INVESTIGATION

You are advised that in connection with your application for employment, AACOG 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 the 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, AACOG will provide you a copy of any consumer report obtained therein and a summary of your rights under the Act. If selected for an interview you will be required to complete the Consent to Background Search and Investigation form.

Signature Date

Please note: Your resume may be attached to this job application.