Phil Camus, Constable Precinct 5 - Harris County, Texas APPLIC… · 3 OFFICE OF Phil Camus, Constable Precinct 5 Instructions to Applicant A. If you meet all of the minimum requirements

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Application for Employment

Phil Camus, Constable Precinct 5 Harris County

17423 Katy Freeway, Houston, Texas 281-492-3557

Revised 09/10

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OFFICE OF

Phil Camus, Constable Precinct 5

Employment Application of:

Name_________________________________________________________________

Last Name First Name Middle Name

Home number (________) _____________________________________

Work number (________) _____________________________________

Cell phone number (________) _____________________________________

Email address _______________________________________________

Position applying for:

Deputy Dispatch Clerical

We suggest you make a copy of this application for your own records.

Office use only

(time stamp)

Date & time

Received

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OFFICE OF


Instructions to Applicant

A. If you meet all of the minimum requirements then complete the application, leaving

nothing blank. If a question does not apply to you then explain why. If you need more

space to answer any questions, attach additional sheets.

B. A copy of the following documents must be submitted with the completed application.

Do not enclose original documents; bring the originals to the initial interview.

Birth Certificate from Bureau of Vital Statistics

Naturalization Certificate

Drivers License (front and back)

Social Security Card

High School Diploma

GED Certificate

Official College Transcript if applicable

Basic Police Academy Graduation Certificate

Letter from TCLEOSE indicating passing test score

If you are a Veteran, form DD214. If you received a medical discharge and are

receiving disability compensation, you must submit page 4 of the DD214 and provide

evidence of your disability.

You may attach any and all copies of police related certificates as well as copies of

military educational certificates with your application.

C. Credit Reports are obtained at your expense. You may use but are not limited to using the

following organizations.

CSC Credit Services, Inc. Montgomery County Credit Bureau Services

652 N. Sam Houston Pkwy E 2040 N. Loop 336 West, Suite 306

Houston, Texas 77060 Conroe, Texas 77304

281 878-1900 / 1-800-305-7868 936-756-7741

http://www.csc.com/credit_services http://www.montgomerycountycreditbureau.com/

You may obtain a free credit report from any one of the three credit bureaus available through:

https://www.annualcreditreport.com/cra/index.jsp

You may link to the site through the federal trade commission website to avoid being misdirected

to other websites.

http://www.csc.com/credit_serviceshttp://www.montgomerycountycreditbureau.com/https://www.annualcreditreport.com/cra/index.jsp

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OFFICE OF


Requirements

Age

Deputy Position at least 21 years of age on date of employment

Non-deputy Position at least 18 years of age on date of employment

Physical Condition

Deputy applicants must be examined by a licensed physician and be declared

physically sound and free from any defects which may adversely affect the

performance of his/her duties. A drug test will be conducted and the result must show

no trace of dependency on drugs or the usage of any illegal drugs, including marijuana.

In addition, eyesight must be correctable to 20/20, and the applicant may have no

uncorrectable hearing defects. The cost of these exams is not reimbursed.

Psychological Evaluation

Deputy applicants must be examined by a licensed psychologist (or psychiatrist) and

be declared in writing, by that professional, to be of satisfactory psychological and

emotional health to be a peace officer. Deputy applicants currently employed as law

enforcement officers may be exempt. The cost of this exam is not reimbursed.

Polygraph Examination

All applicants are required to take a pre-employment polygraph examination. The cost

of this exam is not reimbursed.

Education

Applicant must have a high school diploma or GED.

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OFFICE OF


Certification

Deputy applicants must be certified by TCLEOSE or be currently enrolled in a TCLEOSE

accredited academy.

Residency

Deputy applicants must be a citizen of the United States of America.

Texas Drivers License

Deputy applicants must have a current, valid Texas Driver's License.

Military

Applicants must not have been discharged from any military service under less than

honorable conditions including, specifically; under other than honorable conditions,

bad conduct, dishonorable or any other characterization of service indicating bad

character.

Applicants must not have been convicted in a military court for an offense, for which

the elements would have been a Class B misdemeanor (or above).

Credit

Applicants must have a good credit history and must demonstrate a reasonable

willingness and ability to meet their financial responsibilities in a timely manner.

Past Employment

Past employment history, number of jobs, reason for leaving, employment references,

etc., will be considered. An unfavorable prior employment record may be grounds for

rejection.

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OFFICE OF


Background investigation

A thorough background investigation is conducted on all applicants. Evidence of good

moral character and reputation is mandatory. Disclosure of any one or more of the

following may be grounds for rejection:

Convicted of any felony offense

Convicted of any misdemeanor offense

Convicted of driving while intoxicated

Convicted of driving under the influence of drugs

Currently on probation for any criminal offense

Currently under indictment, or awaiting trial on any criminal offense/charge

Current involvement in unsettled litigation may result in rejection or suspension

of application

Excessive traffic or collision convictions

An unfavorable drug history

Revocation of peace officers license by TCLEOSE

Bad credit history or failure to meet financial obligations

Military discharge under less than honorable conditions

Execution, at any time, of a confession to a felony offense, such confession

being admissible as evidence against the person in any criminal procedure in

any state or federal court

Membership in any subversive or extremist organization

Evidence of any mental or emotional instability

Any fraud, deception or any false statement of fact in this application can be grounds

for rejection.

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OFFICE OF


Applicant Hiring Process

There are six (6) steps in the hiring process. No one will be hired until the final step is completed.

No one has the authority to circumvent these steps. NEVER ASSUME OR THINK YOU HAVE BEEN

HIRED UNTIL COMPLETION OF THE FINAL STEP.

The steps in the hiring process are:

1. Receipt of application and preliminary criminal background check of applicant.

2. An oral interview and pre-employment test conducted by the Personnel and Training

Division. Applicant will be notified of time, date and location of interview.

3. A complete background investigation conducted by the Personnel and Training Division

including but not limited to the information provided by the applicant in the application.

4. An oral interview conducted by a three member review board.

5. A drug screening test, polygraph exam, psychological exam, medical exam and finger

printing; all are conducted by professionals chosen by Precinct 5 and paid for by the

applicant.

6. Oral interview and swear in with the Constable.

I have read the preceding and understand that I may be rejected at any time in the hiring process.

Additionally, I understand that all initial offers of employment are conditional, contingent upon

successful completion of all phases of the hiring process required by the Department and/or State

Law. I also understand that no one has the authority to extend a final offer of employment except

the Constable, and this will only happen after all of the steps listed above are completed.

NOTE: Once hired, you will begin your training phase with an FTO. The Training Program must

be successfully completed in order for the deputy in training to proceed to his/her duty

assignment. If the training phase is not successfully completed, the individual will not be allowed

to continue their employment with this agency.

_______________________________________________________________ Applicants Printed Name

_______________________________________________________________

Applicants Signature

______________________________________________________________

Date

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OFFICE OF


Applicants Please Note

As positions become available, Precinct 5 reviews the open applications on

hand and hires the most qualified applicants.

An application is considered open for one year from the date of receipt, or

until either the person is hired or the application is rejected.

If the application is considered favorably you will be notified when and where

to appear for further processing.


_______________________________________________________________


______________________________________________________________

Date

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OFFICE OF


Confidential Agreement

A thorough and comprehensive investigation will be conducted on all

applicants for employment with the Harris County Precinct 5 Constables

Office. All information is confidential and the department will not reveal the

reason for rejection to those applicants who are not accepted. At no time will

any part of the investigation be made available to you.

I have read and fully understand the above statement and agree that all

information obtained during the application process will remain confidential

and will not be made available to me.


_______________________________________________________________


______________________________________________________________

Date

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OFFICE OF


Release and Indemnity

It has been explained to me, and I fully understand, that in connection with my

applying for a position with the Harris County Precinct 5 Constables Office,

there will be costs incurred by me for:

Any and all:

1. pre-employment polygraph examinations

2. medical

3. psychological and/or emotional tests and evaluations

4. finger printing

5. documents required to be submitted

I also fully understand that I am not guaranteed a position of employment with

the Harris County Precinct 5 Constables Office and I may be rejected for

employment at any time even though I will have expended funds for

examinations and documents. I have decided to proceed with my application

even though I know the costs incurred by me will not be reimbursed and I

agree to hold the Harris County Precinct 5 Constables Office harmless from

any loss incurred by me during and after my application process.

_______________________________________________________________

Applicants Printed Name

_______________________________________________________________


______________________________________________________________

Date

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OFFICE OF


Important

You are required to sign this form before a notary public and have your signature duly

notarized.

I, ________________________________________, hereby swear/affirm that I have personally

completed this employment application. I am aware of the contents and the answers

to all questions and statements made by me are true and correct.

I am also aware that any willful misrepresentation of fact(s) or falsification of any

answer or statement made by me herein will subject me to rejection, dismissal and

criminal prosecution under article 37.02 and/or article 37.10 of the Texas penal code.

Signature of Applicant Date and Time

State Of Texas

County Of Harris

Sworn and subscribed before me this __________ day of _________________________, 20______.

___________________________________

Notary Public Signature

(seal) ___________________________________ Printed Name

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Texas Commission on Law Enforcement Background Investigation - Authority to Release Information Waiver

OFFICE OF


Authority to Release Information

To Whom It May Concern:

I hereby authorize Harris County Constable Precinct 5 and its authorized representatives bearing this release, or a copy

thereof, within one year of its date, to obtain any information in your files pertaining to my employment, military, credit,

education or medical records, including but not limited to academic, achievement, attendance, athletic, personal history,

and disciplinary records, medical records, and credit records.

I hereby direct you to release such information upon request of the bearer. This release is executed with full knowledge

and understanding that the information is for official use. Consent is granted to all parties to furnish such information, as

described above, to third parties in the course of fulfilling its official responsibilities. I hereby release you, as custodian of

such records, and any school, college, university, or other educational institution, hospital, or other repository of medical

records, credit bureau, lending institution, consumer reporting agency, or retail business establishment including its

officers, employees, or related personnel, both individually and collectively, from any and all liability for damages of

whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this

authorization and request to release information, or attempt to comply with it.

A photocopy of this release form will be valid as an original thereof, even though the said photocopy does not contain an

original writing of my signature.

Should there be any question as to the validity of this release, you may contact me as indicated below:

_________________________________________________________________________________________________ Applicants Name (print) Phone Number _________________________________________________________________________________________________ Applicants Address _________________________________________________________________________________________________ City State Zip Code ________________________

Signature of Applicant Date and Time State Of Texas County Of Harris Sworn and subscribed before me this ______________ day of __________________________________, 20_________. ________________________________________ Notary Public Signature (seal) ________________________________________ Printed Name

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OFFICE OF


All sections of the application must be personally completed by the applicant.

Print all information in black ink. Do not type.

Personal History

Name:

Last Name First Name Middle Name

Date of Birth: Age:

Drivers License Number: _____________________________ State:

Social Security Number: __________________________________________________________

Address: ____________________________________________________________________________

______________________________________________________________________________________

City County State Zip Code

Telephone Number(s): _________________ _________________ ___________________

Home Cell Phone Work

Maiden name, nicknames, or other names you have been known by:

_____________________________________________________________________________________

Place of Birth: _____________________ __________________ ____________________

City County State

Are you a citizen of the United States? ______ yes _______ no

Height: _________ Weight: __________ Eye Color: __________ Hair Color: _________

Describe any scars, tattoos or other distinguishing marks you have:

______________________________________________________________________________________

______________________________________________________________________________________

Note: Precinct 5 policy requires that no employee while on duty or in uniform may have tattoo(s)

that are visible to the public. This may require you, if tattoo(s) are visible, to wear a long sleeve

uniform shirt.

With whom do you reside? _________________________________________________________

Name Relationship

Are you related to an employee of this department?

_____ yes ______no (if yes, provide the following)

Name Relationship

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OFFICE OF


Do you know any current or previous Harris County Precinct 5 employees?

_____yes _____no (if yes, please list names.)

___________________________________________________________________________________________________________

Have you ever worked for Harris County Precinct 5 in any capacity?

_____yes _____no (if yes, provide the dates and divisions.)

Date Division

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Have you ever submitted an application to this agency?

_____yes _____no (if yes, provide the date of application.)

____________________________________________________________________________________________________________

Are you willing to work?

Any Shift yes no

Holidays yes no

Weekends yes no

Criminal and Civil History

Have you ever been detained, arrested or issued a criminal citation (other

than traffic citations) by a law enforcement agency either as a juvenile or an

adult?

_____yes _____no (if yes, explain in detail. Use a separate sheet of paper if necessary.)

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

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OFFICE OF


Have you ever committed a Class B (or above) criminal offense for which you

were not arrested?


_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Have you ever been listed as a suspect or defendant in a criminal or civil

case?


_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Do you associate with anyone who has committed a Felony offense?


_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Do you associate with anyone who has committed multiple criminal offenses

(Class B or above)?


_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

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OFFICE OF


Do you associate with any gang members?

_____yes _____no (if yes, provide their names and frequency of contact.)

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Have you ever stolen or taken items or money, from an individual, employer,

business or entity without permission?

_____yes _____no (if yes, explain in detail providing dates, description of the item, value, and

circumstances.)

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Have you ever purchased or received items that you knew or suspected were

stolen?

_____yes _____no (if yes, explain in detail providing dates, description of the item, value, and

circumstances.)

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Do you consume alcoholic beverages?

_____yes _____no (if yes, please describe the frequency and quantity of your consumption.)

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OFFICE OF


In the past 12 months have you operated a motor vehicle after consuming

enough alcohol to be considered intoxicated?

_____yes _____no (if yes, explain each instance.)

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Have you ever tried, used, or experimented with any illegal drug or narcotic,

including prescription drugs not prescribed to you by your doctor?

(do not include over-the-counter drugs that can be legally purchased without a prescription)

_____yes _____no (if yes, provide the following.)

drug name # of times used first time used (mm/yy) last time used (mm/yy)

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Have you ever sold, furnished or transferred any illegal drugs or narcotics

including prescription drugs?


drug name # of times first time sold (mm/yy) last time sold (mm/yy)

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

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OFFICE OF


Have you ever bought or received any illegal drugs or narcotics including

prescription drugs not prescribed to you by a doctor?


drug name # of times first time bought (mm/yy) last time bought (mm/yy)

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Are you now or were you ever a party to a civil litigation (including evictions,

repossessions and divorces).


Type of Litigation City/State Date Disposition

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Have you ever been sued?

_____yes _____no (if yes, explain in detail, providing the dates, amount of suit, and

circumstances.)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Have you ever been summoned into court?

_____yes _____no (if yes, explain in detail, providing the dates and reason.)

________________________________________________________________________________________________

________________________________________________________________________________________________

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OFFICE OF


Traffic Record

Please list the vehicles you and/or your spouse own.

Year Make Model Lic# Insurance Provider Policy Number

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Do you presently hold or have you ever held a drivers license issued by

another state? _____yes _____no (if yes, complete the following)

State License Number Dates Held

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Has your drivers license ever been suspended or revoked?

_____yes _____no (if yes, provide the dates and a detailed explanation.)

Date Explanation

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

List all traffic citations you have received, excluding parking citations. Attach

additional sheets if necessary.

Date Issuing Agency Offense Disposition

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

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OFFICE OF


List all motor vehicle crashes in which you have been involved.

Date Offense Disposition (indicate at fault/not at fault)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Education History

Police Academy attended: _________________________________________________________

City: _____________________________________________ State: ___________________________

TCLEOSE hours received: __________________________

Special awards received: ________________________________________________________

Dates attended: ____________________________________________________________________

Anticipated graduation date: ______________________________________________________

College or University attended: ___________________________________________________

City: _________________________________________ State: _____________________________

Dates attended: from:______________________________ to: ____________________________

Did you graduate? _______________

Number of hours completed: __________________________

Degree received: ___________________________________________________________________

High School attended: _____________________________________________________________

City: _______________________________________________ state: __________________________

Dates attended: from: _____________________________ to: ____________________________

Did you graduate? ___________ If not, do you have a GED? ____________________

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OFFICE OF

Phil Camus, Constable Precinct 5 List all other schools attended such as trade, vocation, business, etc. Give

name, address of school, dates attended, course of study, certificate received

and any other pertinent information:

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

List any specialized machinery or equipment you are able to operate:

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Do you speak a foreign language? ____yes _____no (if yes, complete the following.)

Language Speak Read Write

___________________________________

____________________________________________

___________________________________

Military History

Have you served in the United States Armed Forces? ____yes _____no

Branch of Service: _________________________________________________________________

Are you currently serving in the Military Reserves? ____yes _____no

Type of discharge: _________________________________________________________________

List any disciplinary actions:

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

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OFFICE OF


Marital & Family History

Marital status:

Single: yes no

Married: yes no how long? ______________________________________

Common law: yes no how long? ______________________________________

Divorced: yes no how long? ______________________________________

Widowed: yes no how long? ______________________________________

List name of spouse or former spouse(s) and provide requested information. If

former spouse is deceased provide name and indicate deceased after date

of birth.

Name DOB (mm/dd/yy) Address Phone Length of Marriage

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Are you required to make child support payments? _____yes _____no

If yes, are you current with all payments? _____yes _____no (if no, provide the

number of payments you are behind and fully describe the reason for the

delinquency.)

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

23

OFFICE OF


List all children related to you or your spouse (natural, adopted, step children

and foster children)

Name DOB (mm/dd/yy) Address Phone

If married list spouses employer, address & phone number:

List the following relatives, please indicate if deceased.

(Include step brother or sister)

Relation Name Address DOB Phone Number

Father_______________________________________________________________________________

Stepfather__________________________________________________________________________

Mother______________________________________________________________________________

Stepmother_________________________________________________________________________

Sister_______________________________________________________________________________

Sister_______________________________________________________________________________

Brother _____________________________________________________________________________

Brother _____________________________________________________________________________

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OFFICE OF


Financial History

List all sources of income (including spouses) and amount per year.

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Do you have a bank account? _____yes _____no (If yes, provide the following.)

name of bank phone checking/saving

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Give name and address of individuals, companies, or others to whom you are

indebted and the extent of your debt. Include rent, mortgages, vehicle

payments, charge accounts, credit card loans, child support payments and

any other debts or payments. Attach additional sheets if needed.

creditors name phone # type of debt total monthly payment/balance

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

List any accounts in which you are currently behind in payment thirty days or

more. If none, write none (include charge-offs & collections).

creditors name phone # type of debt amount behind

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

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OFFICE OF


Have you ever had anything repossessed?

_____yes _____no (if yes, provide date, item, and circumstances.)

Date Item Circumstance

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Have you had any check(s) returned due to insufficient funds in the past

twelve months?

_____yes _____no (if yes, provide the date, amount, and circumstances.)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Have you ever filed for bankruptcy?

_____yes _____no (if yes, provide the date, type of bankruptcy, and circumstances.)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Membership in Past & Present Organizations

Name of Organization Type of Organization Date of Membership

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

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______________________________________________________________________________________

______________________________________________________________________________________

OFFICE OF


List your hobbies and recreational activities

Personal Declarations

List all applications you have submitted to other law enforcement agencies.

Provide the current status of each application, if rejected then explain why.

Use a separate sheet of paper if necessary.

Agency Date Submitted Status

Have you ever taken a polygraph examination?


Agency/Company Date Reason Outcome (pass/fail)

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

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OFFICE OF


Are you now or have you ever been a member of a radical or subversive group?

____yes _____no (if yes, provide the following.)

Name of Group Dates of Membership

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Are there any incidents in your life not mentioned herein which may influence this

departments evaluation of your suitability for employment?

____yes _____no (if yes, explain in detail. Use a separate sheet of paper if necessary.)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Have you ever been named in an Internal Affairs Investigation or an investigation

conducted by an employer alleging wrongdoing?


________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Have you ever resigned in lieu of termination?


________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

28

OFFICE OF


Personal Statement

State in your own words why you are seeking employment with

Harris County Precinct 5 Constables Office.

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

29

OFFICE OF


Employment History

List all job history since the age of sixteen (16) starting with current or most

recent position. List all employment regardless of length, including part time,

temporary and seasonal positions. If you were unemployed during any period

of time, list the dates and write unemployed on the line provided for

company name. Be sure there are no gaps. Include month & year. If needed

make additional copies of this section.

From: To:

Name of Employer: _____________________________________ Phone:___________________

Address: ____________________________________________________________________________

Position(s) held: ____________________________________________________________________

Job duties: _________________________________________________________________________

Immediate Supervisor: _________________________________ Phone:___________________

Co-worker:_______________________________________________ Phone:__________________

Salary, beginning: _________________________________ending:_________________________

Were you terminated or asked to resign? _________________________________________

Reason for leaving (explain fully):_________________________________________________

From: To:


Address: ____________________________________________________________________________

Position(s) held: ____________________________________________________________________

Job duties: _________________________________________________________________________


Co-worker:_______________________________________________ Phone:__________________




30

OFFICE OF


From: To:


Address: ____________________________________________________________________________

Position(s) held: ____________________________________________________________________

Job duties: _________________________________________________________________________


Co-worker:_______________________________________________ Phone:__________________




From: To:


Address: ____________________________________________________________________________

Position(s) held: ____________________________________________________________________

Job duties: _________________________________________________________________________


Co-worker:_______________________________________________ Phone:__________________




From: To:


Address: ____________________________________________________________________________

Position(s) held: ____________________________________________________________________

Job duties: _________________________________________________________________________


Co-worker:_______________________________________________ Phone:__________________




31

OFFICE OF


From: To:


Address: ____________________________________________________________________________

Position(s) held: ____________________________________________________________________

Job duties: _________________________________________________________________________


Co-worker:_______________________________________________ Phone:__________________




From: To:


Address: ____________________________________________________________________________

Position(s) held: ____________________________________________________________________

Job duties: _________________________________________________________________________


Co-worker:_______________________________________________ Phone:__________________




From: To:


Address: ____________________________________________________________________________

Position(s) held: ____________________________________________________________________

Job duties: _________________________________________________________________________


Co-worker:_______________________________________________ Phone:__________________




32

OFFICE OF


Personal References

List four (4) personal references including current phone numbers.

Do not include relatives.

Name________________________________________________________________________

Home number (________) _____________________________________________________

Work number (________) _____________________________________________________

Cell number (________) _____________________________________________________

Address______________________________________________________________________

Occupation________________________________ Years Known__________________

Phone number and best time reference prefers to be contacted

(_______) ____________________________________________ Time___________________

Name________________________________________________________________________

Home number (________) _____________________________________________________

Work number (________) _____________________________________________________

Cell number (________) _____________________________________________________

Address______________________________________________________________________



(_______) ____________________________________________ Time___________________

Name________________________________________________________________________

Home number (________) _____________________________________________________

Work number (________) _____________________________________________________

Cell number (________) _____________________________________________________

Address______________________________________________________________________



(_______) ____________________________________________ Time___________________

Name________________________________________________________________________

Home number (________) _____________________________________________________

Work number (________) _____________________________________________________

Cell number (________) _____________________________________________________

Address______________________________________________________________________



(_______) ____________________________________________ Time___________________

33

OFFICE OF


Residence History

Beginning with your present address list all addresses where you have lived

including month and year. Attach additional sheets if necessary.

From ________________ To __________________ house________ apartment_______

Address______________________________________________________________________

City ___________________________________ State _____________ Zip ______________


Address______________________________________________________________________

City ___________________________________ State _____________ Zip ______________


Address______________________________________________________________________

City ___________________________________ State _____________ Zip ______________


Address______________________________________________________________________

City ___________________________________ State _____________ Zip ______________


Address______________________________________________________________________

City ___________________________________ State _____________ Zip ______________


Address______________________________________________________________________

City ___________________________________ State _____________ Zip ______________


Address______________________________________________________________________

City ___________________________________ State _____________ Zip ______________


Address______________________________________________________________________

City ___________________________________ State _____________ Zip ______________

Documents

Phil Camus, Constable Precinct 5 - Harris County, Texas APPLIC… · 3 OFFICE OF Phil Camus, Constable Precinct 5 Instructions to Applicant A. If you meet all of the minimum requirements