Careers

Application for Employment

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of disability, or any other legally protected status.

Application for Employment

Date of Application(Required)

Month

Day

Year

Position Applying For(Required)

First Name(Required)

Middle Name(Required)

Last Name(Required)

(Maiden if applicable)

Address(Required)

Street Address City State ZIP Code

Telephone

Cell Phone

Other

Are you eighteen (18) years of age or older?(Required)

Yes

Are you legally eligible to work in the United States? (Documentation required if hired)(Required)

Yes

Do you have a valid driver’s permit?(Required)

Yes

If yes, what type?

Have you ever filed an application here before?(Required)

Yes

If yes, give dates.

Have you ever been employed here before?(Required)

Yes

If yes, give dates.

Are you employed now?(Required)

Yes

If yes, may we contact your present employer for references?

Yes

On what date would you be available for work?(Required)

Availability for work (check all that apply)(Required)

Full-time

Part-time

Health Provider

Can you travel if the job requires it?(Required)

Yes

Are you related to anyone who is presently employed by South Plains Public Health District?(Required)

Yes

If yes, give name and relationship.

Have you been convicted of a felony within the last 7 years?(Required)

Yes

(Conviction will not necessarily disqualify applicant from employment)

If yes please explain

Do you have any current obligations as a result of conditions of probation or parole?(Required)

Yes

If yes please explain

Veteran of the U.S. Military?(Required)

Yes

If yes, Branch:

Active Duty Discharge Date:

Check any that apply:

Vietnam Veteran

Disabled Veteran

Other(specify)

If "Other" Specify here:

Indicate languages, other that English, you speak, read, and/or write

High School or GED completed:(Required)

Yes

If no, give highest grade completed

Colleges, Universities or Trade Schools attended:

Name of School

City/State

Number of years attended or degree attained

Subjects studied or degree major

Click the + on the end of the section to add sections.

Give name, address, and telephone numbers of three personal references who are not related to you and are not previous employers.(Required)

Name

Address

Years Known

Relationship

Daytime Telephone(s)

Click the + on the end of the section to add sections.

Give name, address, and telephone numbers of three business references who are not related to you.(Required)

Name

Address

Years Known

Relationship

Daytime Telephone(s)

Click the + on the end of the section to add sections.

Employment History

Start with your present or most recent employment. Attach additional pages if needed. SPPHD will assume we may contact these employers for job related references unless you indicate otherwise. This section must be completed in full. (Do not leave bland and refer to resume.)

Company:

Telephone number:

Address (include city and state):

Dates of employment: (Start month and year)

Dates of employment: (End month and year)

Hours

Full-time

Part-time

Other

If other specify here:

Name and title of supervisor:

Starting hourly pay:

Ending hourly pay:

State job title and describe work performed:

Reason for leaving:

Company:

Telephone number:

Address (include city and state):

Dates of employment: (Start month and year)

Dates of employment: (End month and year)

Hours

Full-time

Part-time

Other

If other specify here:

Name and title of supervisor:

Starting hourly pay:

Ending hourly pay:

State job title and describe work performed:

Reason for leaving:

Company:

Telephone number:

Address (include city and state):

Dates of employment: (Start month and year)

Dates of employment: (End month and year)

Hours

Full-time

Part-time

Other

If other specify here:

Name and title of supervisor:

Starting hourly pay:

Ending hourly pay:

State job title and describe work performed:

Reason for leaving:

Company:

Telephone number:

Address (include city and state):

Dates of employment: (Start month and year)

Dates of employment: (End month and year)

Hours

Full-time

Part-time

Other

If other specify here:

Name and title of supervisor:

Starting hourly pay:

Ending hourly pay:

State job title and describe work performed:

Reason for leaving:

If the position for which you are applying requires proficiency testing, are you willing to take the test?(Required)

Yes

SPPHD has a Drug-Free work place policy. If you are employed, you may be required to submit to a drug/alcohol test. If so, are you willing to submit to drug/alcohol testing?(Required)

Yes

If employed, are you willing to allow a Criminal History Check to be conducted?(Required)

Yes

Applicant Statement

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at a decision and I agree to release all parties providing pertinent information from any and all liability from any damages which may result from the furnishings of such information. SPPHD only accepts applications for open positions. I understand that this application may be considered active for a period of up to 60 days. I understand that neither this document nor any offer of employment from the employer constitutes an employment contract. I also understand that SPPHD is an “at will” employer and employees can be terminated at any time, with or without cause, and with or without notice. I also understand that no employment with SPPHD is for a fixed or definite term. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand that all SPPHD employees are required to abide by all rules and regulations of SPPHD. I understand that the signature below indicates agreement to the Applicant Statement above.

Signature of Applicant

Date

MM slash DD slash YYYY

File Upload

Applicants are encouraged to also submit attachments such as cover letters, resumes, copies of certifications, or other job related information, SPPHD only accepts applications for specific open positions.

File

Drop files here or

Accepted file types: pdf, jpg, doc, docx, Max. file size: 1,000 MB.

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