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Employment & Contracting

Austin Travis County Mental Health Mental Retardation Center
Application for Employment


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



Please indicate which positions you are interested in using the 9-digit job number. Click here to view current openings. Your application will remain on file for 6 months.

PERSONAL INFORMATION

Last Name, First Name:
Social Security Number (Last four digits):
Street Address:
City: State: Zip Code:
Phone Number: ( ) -
Have you previously been employed with ATCMHMR? Yes No If yes, when?
Do you have any relatives employed by ATCMHMR or serving on the Board of Trustees? Yes No
If yes, who?
Under what names have you previously been employed?
On what date would you be available for work?
Are you available for: Full-time  Part-time  Shift Work  Relief
List any hours, shifts, or days you cannot or will not work:
Are you prevented from lawfully becoming employed in this country due to or Immigration Status?
Yes No (Proof of citizenship/immigration status is required within three (3) working days of hire date if you begin employment with ATCMHMR.)
Has it ever been confirmed that you engaged in any class of client abuse/client neglect in any previous employment? Yes No
If yes, provide the employer's name, the year, and the offense which was confirmed:
As an adult, have you ever been convicted of anything other than a minor traffic violation? Yes No
If yes, list all such offenses, dates, name of Court, and disposition:
Military Service Branch: Dates:
Honorable Discharge? Yes No

SKILLS SUMMARY

List all current and valid licenses and certificates you hold: (Driver's, Nursing, LPC, etc.)
Type: Number: Expiration Date:
Type: Number: Expiration Date:
Type: Number: Expiration Date:
List any secondary languages you can fluently speak, read or write (including American Sign Language):
Indicate those skills you have at least one year experience with:
Assessment Driving Medicaid
Budgeting Dual Diagnosis Mental Health
Case Management Filing Mental Retardation
Children's Mental Health General Maintenance Mobility Impaired
Clinical Health Care Psychologist
Computer HIV/AIDS Substance Abuse
Cooking In-Patient Supervisor
Counseling Intake Switchboard
Crisis Intervention Linkage Treatment Plans
Customer Service Managed Care Typing
Data Entry Management Word Processing
Other:

EDUCATION

High school Name and Address:
 Graduated: Yes No  
College/University Name and Address:
 Graduated: Yes No
Semester Hours Completed 		Degree


Major
Graduate School Name and Address:
 Graduated: Yes No
Semester Hours Completed 		Degree


Major
Technical/Vocational Name and Address:
 Graduated: Yes No
Semester Hours Completed 		Degree


Major

EMPLOYMENT EXPERIENCE

List all employment, including military service, for the past five years. Begin with your present or most recent position.
Employer Name:
Address:
Telephone Number: ( ) -
Supervisor's Name: May we contact this supervisor? Yes No
Your Title/Position:
Employment Dates: through:
Salary/Wage: $ per:
Reason for leaving:
Primary work performed:
Employer Name:
Address:
Telephone Number: ( ) -
Supervisor's Name: May we contact this supervisor? Yes No
Your Title/Position:
Employment Dates: through:
Salary/Wage: $ per:
Reason for leaving:
Primary work performed:
Employer Name:
Address:
Telephone Number: ( ) -
Supervisor's Name: May we contact this supervisor? Yes No
Your Title/Position:
Employment Dates: through:
Salary/Wage: $ per:
Reason for leaving:
Primary work performed:

PROFESSIONAL REFERENCES

List three (3) persons who have knowledge of your experience or ability in the work place. Please provide name, address, phone, occupation and years known:
1.
2.
3.

RESUME

Attach your resume here:

ADDITIONAL INFORMATION
Attach any additional information here:

APPLICANT'S STATEMENT

I certify that the answers given herein are true, correct 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 an employment decision. I understand that this application is not and is not intended to be a contract of employment.

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 also, that I am required to abide by all rules and regulations of the Austin Travis County MHMR Center.

I understand and agree if selected for employment, my term of employment is not for any definite period. I understand that employment at this Center is "at will," which means that either I or the Center can terminate the employment relationship at any time, with or without prior notice, and with or without cause.

I also understand that this Center will check conviction records on applicants recommended for hire which may make me ineligible for continued employment and lead to my immediate dismissal. I also understand that driving records will be checked and participation in the Center's Controlled Substance Testing Program is required if I am required to drive as a part of my job duties, and that such record or test results may make me ineligible for employment or continued employment and lead to dismissal.

I understand that I may be requested to sign a release authorizing previous employers to release to ATCMHMR information concerning my previous employment, including reasons for my separation and any information concerning client abuse/client neglect investigations.

Clicking on SUBMIT indicates an acceptance to the Applicant's Statement.

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