Affirmative Action/equal Employment Opportunity/mfd Employer - Employment Application - Cameron County Page 4
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4REFERENCES
List 3 persons not related to you who have definite knowledge of your character, qualifications, and fitness for the position you are
applying for. Do not repeat names listed in the Employment History.
______________________________________________________________________________________________________________
Name: ________________________________________________________________________
FOR EMPLOYER USE ONLY
Address: ______________________________________________________________________
Home Telephone: _______________________________________________________________
Occupation: ___________________________________________________________________
Work Telephone: _______________________________________________________________
How long has reference known you? ________________________________________________
FOR EMPLOYER USE ONLY
Name: ________________________________________________________________________
Address: ______________________________________________________________________
Home Telephone: _______________________________________________________________
Occupation: ___________________________________________________________________
Work Telephone: _______________________________________________________________
How long has reference known you? ________________________________________________
Name: ________________________________________________________________________
FOR EMPLOYER USE ONLY
Address: ______________________________________________________________________
Home Telephone: _______________________________________________________________
Occupation: ___________________________________________________________________
Work Telephone: _______________________________________________________________
How long has reference known you? ________________________________________________
State any additional information you feel may be helpful to us in considering your application: __________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
AUTHORIZATION AND AGREEMENT
Please read before signing. If you have any questions, please ask.
Cameron County is an equal opportunity employer and does not discriminate in its recruiting, selection, and hiring procedures because of
race, color, sex, religion, national origin, age, disability, citizenship, veteran status, political affiliation or belief, or any other non-job
related factor.
I authorize the references and prior employers listed above to give Cameron County any pertinent information they may have, personal
or otherwise, and release all parties from all liability for any damage that may result from furnishing same to Cameron County.
I hereby affirm that the information provided in this Application for Employment is true, correct, and complete. If employed, any
misstatements or omission of fact on this application may result in my dismissal.
I understand that completion of this employment application form does not constitute any type of employment agreement or contract. I
further understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to
employ me in the future. (Social Security number, driver’s license, home address and date of birth may be requested as a condition for
employment at time of job offer.)
Signature:
Date: _______/________/________
___________________________________________________________________________________________________________________________
FOR PERSONNEL USE ONLY
Interviewer/Department:
Date: _______/_______/___________
Summary Remarks: ______________________________________________________________________________________________
Employed: No
Yes
DOH:
/
/
Salary/Hourly rate: $______________
Job Title: ____________________________________
Department: _______________________________________________
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Parent category: Business