Application For Employment Form - Brazoria County Appraisal District Angleton, Texas Page 2
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1
2EMPLOYMENT RECORD
List below the last four employers starting with last one first. Dates should be continuous. If unemployed for any period, make note of
unemployment period.
Date
Mo. & Yr.
Reason for
May we
From
To
Name & Employer Address
Salary
Position
Leaving
Contact
REFERENCES
List below the name of three persons not related to you, whom you have known at least one year.
Name
Address
Business
Years
Acquainted
In case of emergency, notify __________________________________________________________________________________
___________________________________________________________________________________________________________
In consideration for rights and privileges of employment with the Brazoria County Appraisal District, I hereby agree to abide by the
District's Rules and Regulations. I hereby authorize any properly designated official to conduct whatever investigation necessary in
connection with the data given herein.
I hold free from liability all former employees or other persons who may in response to inquiries made by the District furnish true
information pertaining to my reputation, employment, and health history and the Brazoria County Appraisal District in the use of such
data in reciprocal inquiries from other companies.
I further agree that if it is found that I have falsified or omitted information from this questionnaire such falsification or omission shall
be construed to be fraud against the District and shall be sufficient grounds for dismissal if I shall be an employee of the company.
I attest to the fact that this application was signed by me.
____________________________
_________________________________________________
Date
Signature
List below any additional information which may be helpful in considering your application.
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