The Agency does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, age, disability, or any other legally protected status.The Agency is an equal opportunity employer.
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I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also understand and agree that any falsified information or significant omissions may disqualify me from further consideration for employment and, if discovered after I am hired, may result in dismissal.
I also understand that if employment is offered and accepted, such employment is not for any specified term and can be terminated at anytime, with or without cause, by either the Agency or myself. I further understand that this application is not a contract of continued employment, and that my at-will employment status cannot be changed.
In consideration of my being considered for employment, I authorize a thorough investigation of my past employment. I agree to cooperate in such investigation, and release from all liability or responsibility all persons and businesses requesting or supplying such information.
I understand that the Agency requires that a Computerized Criminal History (CCH) Check, Employee Misconduct Registry, and OIG searches will be conducted on persons to whom an offer of employment is made. By signing this application, I acknowledge that I have been informed by the agency that a Criminal History Check, Employee Misconduct Registry, and OIG searches will be performed and EMR/NAR are searched annually. I have also informed the agency of all names, (i.e., maiden, aliases) that I have used in the past.
I understand that the Agency does not subscribe to the Worker’s Compensation plan. I further understand that the Agency does provide an occupational injury plan which may provide certain medical benefits to its employees who are injured on the job.
By execution of this document, I acknowledge that I have been informed by the agency that a criminal history, an EMR/NAR, and State and Federal OIG checks will be performed on my name(s). In addition, if I am hired, the agency will verify EMR/NAR annually, and OIG (State & Federal) monthly. I have informed this agency of all names (i.e., maiden name, aliases) that I have used in the past. I hereby profess that I have not been convicted of any of the following crimes which are a permanent automatic bars to employment by this agency.
A person for whom the facility is entitled to obtain criminal history record information may not be employed in a facility if the person has been convicted of an offense listed below:
A person may not be employed in a position the duties of which involve direct contact with a consumer in a facility before the fifth anniversary of the date the person is convicted of:
For purposes of this section, a person who is placed on deferred adjudication community supervision for an offense listed in this section, successfully completes the period of deferred adjudication community supervision, and receives a dismissal and discharge in accordance with Section 5 (c), Article 42.12, Code of Criminal Procedure, is not considered convicted of the offense for which the person received deferred adjudication community supervision.
I acknowledge that if I am found to have been convicted of any other offense(s), that this offense(s) may also bar my employment. Also, if I am found to have been reported to the Employee Misconduct Registry and/or OIG Excluded party Lists (State and/ or Federal), this offense(s) may also bar my employment.
I understand that all information obtained by this agency regarding any criminal history and employee misconduct will remain confidential. I have the right to contact DPS, DADS, and/or OIG to request an opportunity to be heard concerning the accuracy of the recorded information that was disclosed to the agency.
I certify that the information on this form contains no willful misrepresentation and that the information given is true and complete to the best of my knowledge.
acknowledge that a Computerized Criminal History (CCH) check may be performed by accessing the Texas Department of Public Safety Secure Website and may be based on name and DOB identifiers. (This is not a consent form, but serves as information for the applicant.) Authority for this agency to access an individual’s criminal history data may be found in Texas Government Code 411; Subchapter F.
Name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history record information (CHRI), therefore the organization conducting the criminal history check is not allowed to discuss with me any CHRI obtained using the name and DOB method. The agency may request that I also have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search.
In order to complete the fingerprint process I must make an appointment with the Fingerprint Applicant Services of Texas (FAST) as instructed online at www.txdps.state.tx.us /Crime Records/Review of Personal Criminal History or by calling the DPS Program Vendor at 1-888-467-2080, submit a full and complete set of fingerprints, request a copy be sent to the agency listed below, and pay a fee of $25.00 to the fingerprinting services company.
Once this process is completed the information on my fingerprint criminal history record may be discussed with me.
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