Employment Application for Staff Task Worker
Use black ink pen or type. Completely answer all items.
Human Resources | 601 University Dr., JCK Suite 340
San Marcos, Texas 78666 | 512.245.2557
Task Position Job Title for which you are Applying:
PERSONAL INFORMATION
Name (last, first, middle) SSN
Other names used Daytime Phone
Mailing Address
City/State Zip Code
Are you at least 17 years old? Yes No
Are you a current Texas State student? Yes No
If so, # of hours enrolled:
State Employment: Are you currently or have you been previously employed by Texas State? Yes No
For any other State of Texas entity? Yes No
If “yes” to either, provide dates, job title, & entity:
Nepotism: Do you have any relatives by blood or marriage employed at Texas State or serving on the Board of Regents of the Texas State
University System? Yes No
If “yes,” list name(s), relationship(s), and department(s)/unit(s):
Criminal History: Have you ever been convicted of a felony or subjected to deferred adjudication on a felony charge? Yes No
If “yes,” explain in concise detail on a separate page, giving dates and the nature of the offense, name and location of the court,
and disposition of the case(s). A conviction may not disqualify you for employment, but a false statement will. Note: Some
departments may require additional information related to convictions of misdemeanors.
EDUCATION & TRAINING (Applicants may be required to provide proof of diploma, degree, transcript, license, etc.)
State highest grade of school completed (1-12): Did you graduate/achieve a GED?
Undergraduate College/University Name & Location: Degree/Date:
Dates attended: Credit hours completed: Major:
EMPLOYMENT RECORD (Provide your most recent employment experience.)
Current employer: Telephone:
Supervisor name & title: Your position/title:
Mailing Address
City/State Zip Code
Start Date: End Date: Ending Salary: $
Description of duties and responsibilities in order of importance:
Read the following statements carefully and indicate your understanding and acceptance by signing below.
1. I certify that all information provided by me in connection with my application, whether on this document or not, is true and
complete and I understand that any misstatement, falsification, or omission of information shall be grounds for refusal to hire or, if
hired, termination.
2. I understand that, as a condition of employment, I will be required to provide legal proof of authorization to work in the United
States.
3. I understand that Texas State University will check Texas Department of Public Safety and/or the Federal Bureau of Investigation
records for any criminal history in accordance with applicable statutes.
4. I authorize any of the persons or organizations named in my application to give you any and all information about my employment,
education, or other information they might have, personal or otherwise, with regard to any of these subjects. I release all such
parties from all liability from any damages that might result from giving you this information.
THIS APPLICATION MUST BE SIGNED.
Applicant Signature Date
