Texas Traffic and Barricade Employment Application

Employment Application
Applicant Information:
Date

MonthDayYear
Date
Full Name*

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
E-mail
Date Available:

MonthDayYear
Date
Social Security Number:
Position Applied For:
Salary Desired ($)
Are you a citizen of the United States?

YesNo
If no, are you authorized to work in the U.S.?

YesNo
Do you have a valid driver’s license?*

YesNo
Have you ever worked for this company?

YesNo
If yes, when?
Have you been convicted of a felony in the last 7 years?

YesNo
If yes, explain:
If you were referred by a current employee, please list name:
Education:
High School:
Name of High School Attended
Address:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Did you graduate?

YesNo
Diploma:
College:
Name of College/University Attended
Address:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Did you graduate?

YesNo
Degree:
Other:
Name of College/University Attended
Address:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Did you graduate?

YesNo
Degree:
References:

Please list three professional references.
Full Name, Company, and Relationship
Phone Number
Please enter a valid phone number.
Address
Full Name, Company, and Relationship
Name of Reference
Phone Number
Please enter a valid phone number.
Address
Full Name, Company, and Relationship
Name of Reference
Phone Number
Please enter a valid phone number.
Address
Previous Employment:
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary ($)
Ending Salary ($)
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Reason for Leaving?
May we contact your previous supervisor for a reference?

YesNo
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary ($)
Ending Salary ($)
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Reason for Leaving?
May we contact your previous supervisor for a reference?

YesNo
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary ($)
Ending Salary ($)
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Reason for Leaving?
May we contact your previous supervisor for a reference?

YesNo
Military Service-Optional
Branch:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Rank at Discharge:
Type of Discharge (if other than honorable, explain):
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Typed Signature
Date

MonthDayYear
Date
Should be Empty:

Employment Application

Applicant Information:

Education:

References:

Previous Employment:

Military Service-Optional

Disclaimer and Signature