APPLICANT INFORMATION

Full Legal Name*

Physical Address*

Mailing Address

Email Address

Phone Number*

Date of Birth*

Social Security Number*

Texas Driver's License*

Preferred Method of Contact*

Phone

Have you ever been convicted of a felony?*

Yes

Do you have a relative working for the City of Dumas or serving on the City Commission?*

Yes

If so, what is the relationship?

EDUCATIONAL HISTORY

High School Name, Location, and Date of Graduation/Attendance

College/University Name, Location, and Date of Graduation/Attendance

Specialized/Vocational Training Name, Location, and Certificate/Date of Attendance

Other training, certification, experience, or licensure that you feel will benefit the department.

EMPLOYMENT HISTORY - 5 Most Recent Jobs

1.) Company Name, Position Held, Name of Supervisor*

Reason for Leaving*

2.) Company Name, Position Held, Name of Supervisor*

Reason for Leaving*

3.) Company Name, Position Held, Name of Supervisor*

Reason for Leaving*

4.) Company Name, Position Held, Name of Supervisor*

Reason for Leaving*

5.) Company Name, Position Held, Name of Supervisor*

Reason for Leaving*

Is any additional information, such as the use of another name necessary to perform a work record check? Please explain if yes:

REFERENCES

Give the name and telephone number of three references:*

I understand that the City of Dumas is at at will employer and that neither this application nor any City policy gives the employee a property interest in a job.*

I confirm that I currently meet, or will meet, the following selection criteria:*

I am at least 18 years of age

Posses a valid Texas Driver's License

Have a HS Diploma/GED

Vision Correctable to 20/20

Will attend 25% of paged calls

Will attend 50% of trianing/drill

Digital Signature (Last Name and Last 4 digits of your SS#)*

Dumas, TX

Application for Volunteer Membership

APPLICANT INFORMATION

EDUCATIONAL HISTORY

EMPLOYMENT HISTORY - 5 Most Recent Jobs

REFERENCES

City Hall

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