Congratulations on you on your offer of employment with

Congratulations on you on your offer of employment with Tarleton State University!

Please complete this employment application and deliver it along with your ORIGINAL work authorization documents (listed below) to Employee Services, located in the Gough Hall, 1st Floor, during regular business hours, Monday through Friday, 8:00 a.m. to 5:00 p.m.

Once Employee Services receives these documents, you will receive an email within 1-3 business days with instructions to log into Single Sign On (SSO) to access Workday for completion of all new employee documents (contact information, direct deposit, W-2, trainings, etc.). Additionally, you will be given instructions to complete Section 1 of your Federal Form I-9 online via perfectcompliance.com.

When ALL of these items are completed, you will receive an email with a Zoom link to New Employee Orientation. After you have successfully attended orientation, you will receive an email authorizing you to begin work.

You may not begin working until all documents are completed and you receive written clearance from Employee Services.

Your supervisor will be copied on all of the emails sent from Employee Services.

If you have any questions or concerns, please contact [email protected] or call 254.968.9128

mailto:[email protected]

LISTS OF ACCEPTABLE DOCUMENTSAll documents must be UNEXPIRED

Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.

LIST A

2. Permanent Resident Card or AlienRegistration Receipt Card (Form I-551)

1. U.S. Passport or U.S. Passport Card

3. Foreign passport that contains atemporary I-551 stamp or temporaryI-551 printed notation on a machine-readable immigrant visa

4. Employment Authorization Documentthat contains a photograph (FormI-766)

5. For a nonimmigrant alien authorizedto work for a specific employerbecause of his or her status:

Documents that Establish Both Identity and

Employment Authorization

6. Passport from the Federated Statesof Micronesia (FSM) or the Republicof the Marshall Islands (RMI) withForm I-94 or Form I-94A indicatingnonimmigrant admission under theCompact of Free Association Betweenthe United States and the FSM or RMI

b. Form I-94 or Form I-94A that hasthe following:(1) The same name as the passport;

and(2) An endorsement of the alien's

nonimmigrant status as long asthat period of endorsement hasnot yet expired and theproposed employment is not inconflict with any restrictions orlimitations identified on the form.

a. Foreign passport; and

For persons under age 18 who are unable to present a document

listed above:

1. Driver's license or ID card issued by aState or outlying possession of theUnited States provided it contains aphotograph or information such asname, date of birth, gender, height, eyecolor, and address

9. Driver's license issued by a Canadiangovernment authority

6. Military dependent's ID card

7. U.S. Coast Guard Merchant MarinerCard

8. Native American tribal document

10. School record or report card

11. Clinic, doctor, or hospital record

12. Day-care or nursery school record

2. ID card issued by federal, state or localgovernment agencies or entities,provided it contains a photograph orinformation such as name, date of birth,gender, height, eye color, and address

4. Voter's registration card

5. U.S. Military card or draft record

Documents that Establish Identity

LIST B

OR AND

LIST C

7. Employment authorizationdocument issued by theDepartment of Homeland Security

1. A Social Security Account Numbercard, unless the card includes one ofthe following restrictions:

2. Certification of report of birth issuedby the Department of State (FormsDS-1350, FS-545, FS-240)

3. Original or certified copy of birthcertificate issued by a State,county, municipal authority, orterritory of the United Statesbearing an official seal

4. Native American tribal document

6. Identification Card for Use ofResident Citizen in the UnitedStates (Form I-179)

Documents that Establish Employment Authorization

5. U.S. Citizen ID Card (Form I-197)

(2) VALID FOR WORK ONLY WITHINS AUTHORIZATION

(3) VALID FOR WORK ONLY WITHDHS AUTHORIZATION

(1) NOT VALID FOR EMPLOYMENT

Page 3 of 3Form I-9 10/21/2019

Examples of many of these documents appear in the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

KAUFMAN

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KAUFMAN

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TARLETON STAT[ UNIVERSITY

BACKGROUND CHECK DISCLOSURE NOTICE

AUTHORIZATION FORM

This form is used by the Employee Services Department as authoriL.ation to obtain criminal hist01y information on the finali st candidate, as s pecified

below.

-------TO BE COMPLETED BY THE APPLICANT------

Com lete usin Le al

Last Name Fi rst Name Middle Name UIN (i f available)

Other name(s) used in any and all other records of birth or records of residence (including Maiden Name)

Present Physical St reet Address (PO or T Box not allowed) Apartment

City County State Zip

Date of Birth* Gender* Race*

co11.d1tcti11.o a backoro1wd check.

In connection with my application for employment, my continued employment, or in connection with my desi re to engage in volunteer activities , I

have been advised and I hereby consent and authorize Ta rleton State University and its agent, at any time during my application process and/or employment, to obtain a background check, consumer report and/or investigative consumer report that may include, but not be limited to, social security

number verification, a criminal record check, employment and education verifications, verifications of personal reference and reputation; and driving

record. Credit history will not be obtained. I do hereby consent and authorize Tarleton State University and its agent to use any information provided on this form during the application process or during my employment in obtaining a background check, consumer and/or investigative consumer report.

If a consumer or investigative consumer report is obtained on me, I have been informed that I have the right to review and challenge any negative

information received that would adversely impact me or adversely affect a decision to offer employment. If a consumer reporting agency is utilized to secure an investigative consumer report, I understand that I will be provided the name, address and telephone number of the consumer reporting agency

and the nature and scope of the report upon timely request.

I ag ree to release, indemnify and hold harmless Ta rleton State University, any consumer reporting agency, any Federal, State, or local agency and any

law enforcement agency used by Tarleton with rega rd to any information reported

I acknowledge that facsimile, copy or email of this document shall have the same validity, force and effect as the original.

The following are my responses to questions about my criminal history , if any. (Exclude minor traffic offenses punishable only by fine.) IF YOU ANSWER YES TO ANY OF THE F OLLOWING QUESTIONS, ATTACH DETAILS ON A SEPARATE SHEE T OF PAPER TO INCLUDE

THE STATE, COU NTY, DATE OF OF FE NSE AND DETAILS.

1. Have you ever been convicted or plead guilty before a court for any federal, state or municipal criminal offense?

(If es, attach an extra page with the detail s including state, county, date of offense and details of the conviction.)

2. Have you ever received defeITed adjudication or similar disposition for any federal, state or municipal offense?(If yes, attach an extra page with the detail s including state, county, date of offense and details of the dis position.)

3. Have you ever received pretrial diversion or similar disposition for any federal, state or municipal offense?

(If yes, attach an extra page with the detail s including state, county, date of offense and details of the dis position.)

4. Have you ever received probation or community supervision for any federal, state or municipal offense?

(If yes, attach an extra page with the detail s including state, county, date of offense and details of the dis position.)

5. Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States?(If yes, attach an ext111 page with the detail s including state, county, date of offense and details of the conviction.)

6. As of the date of this consent form, do you have any ndin char es a ainst ou? (If yes, attach an ext111 page with the details including state, county, date of offense and details.)

□YES □NO

□YES □NO

□YES □NO

□YES □NO

□YES □NO

□YES □NO

Background Check Authorization and Disclosure-July 2015

LIST ALL COUNTIES AND STATES OF RESIDENCE SINCE IIlGH SCHOOL GRADUATION OR AGE 18. BEGIN WITH MOST RECENT. (Attach extra page if needed.)

City County State

City County State

City County State

City County State

City County State

City County State

City County State

Highest earned educational degree: DA.ssociate DBachelor's DMasters Dnoctorate

Field in which degree awarded: __________________________________ _

Date degree confen-ed: _____________________________________ _

Name of institution granting highest degree: ______________________________ _

Address of institution: _____________________________________ _

Your name while at institution (if different than cutTent name): ________________________ _

(1) I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IN nns BACKGROUND CHECK DISCLOSURE NOTICE ANDAUTHORIZATION FORM IS TRUE, CORRECT AND CO1\1PLETE. I UNDERSTAND THAT INCORRECT OR INCO1\1PLETEINFORMATION MAY BE GROUNDS FOR TERMINATION OF CURRENT El\1PLOYMENT OR CANCELLATION OF ANY AND ALL OFF ERS OF EMPLOYMENT AT THE DISCRETION OF TARL ETON STATE UNIVERSITY.

(2) I UNDERSTAND APPLICANTS ARE REQUIRED TO REPORT ARRESTS MADE BETWEEN THE APPLICATION FOREMPLOYMENT AND DECISION TO HIRE THE APPLICANT FOR EMPLOYMENT.

(3) I HA VE A IT ACHED P AG ES WITH DETAILS OF ARRESTS AND CONVICTIONS FOR ANY AND ALL ''YES" RESPONSES TO QU ESTIONS 1-6 ON THE FIRST P AG E.

SIGNATURE OF APPLICANT OR EMPLOYEE DATE

APPLICANT CONTACT INFORMATION: ______________ _ (Email address) (Phone number)

For California, Minnesota or Oklahoma applicants only, if you wou ld like to receive a copy of the consumer rep01t, if one is obtained, please check this box. D If checked and you are a Califo1nia applicant, a copy of consumer repo1ts received on yout· behalf will be sent within three (3) days of Tarleton receiving a copy of the consumer repo1t.

This form should be retumed to Tarleton State University Employee Services by fax or postal mail to:

Fax: 254-968-9590

Mail address: Tarleton State University

Employee Services

Box T-0510

Stephenville, TX 76402

For questions concerning this fo1m, please call 254-968-9128

Background Check Authorization and Disclosure-July 2015

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Answer all appl icable questions

□ Full-Time □ Part-Time □ Nights

Name (Last, first, middle; other names previously used

Current address ( Street & Number, or PO Box

City, State, Zip

Do you have a current, valid D river's License? If Yes DL#

I Date:

Tarleton State University

Employment Application (Rev 4/2018)

I Click here to enter a date.

□ Temporary

Social Security Number

Home Phone

Work Phone

Type State

Do you have any relative I □ Yes □ No

If yes, lis t names , relationships and place employed: working for TSU Have you ever been employed by

I □ Yes □ NoIf yes: When? Which agency?

the State of Texas previously

Education - Circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12 GED BA/BS MA/MS PdD/EdD

Type of school Name and Location of Graduated? Number of Type of d iploma GPA Major field of study School Yes No semester hours or degree

completed High School

College or University

Technical/ Vocational

Computer Software & Competency: List Additional Ski lls:

□ Microsoft Access D Typing WPM □ Microsoft Excel

□ Copier□ Microsoft Outlook□ Microsoft PowerPoi nt □ Fax

□ Microsoft Publisher □ Scanner

□ Microsoft Word □ Printer□ Adobe Acrobat

If you speak , read, or write a foreign language, please indicate:

Tarleton State University Employment Application Page 1 of 3

Employer: Telephone No.

Mailing address

City, State Zip Code

Start Date End Date Starting Salary Ending Salary Starting Title:

Briefly describe duties & responsibilities (include supervisory experience)

C

Q) Immediate Supervisor

IReason for Leaving

E


E Mailing address UJ City, State Zip Code



Immediate Supervisor

IReason for Leaving


Mailing address




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C Immediate Supervisor

IReason for Leaving

Employer: Telephone No. a

Mailing address E

UJ City, State Zip Code




IReason for Leaving


Mailing address




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C Immediate Supervisor

IReason for Leaving Q)

E

6 Employer: Telephone No. a Mailing address E

UJ City, State Zip Code




IReason for Leaving

Tarleton State University Employment Application

Tarleton State University

Employment Application (Rev 4/2018)

Type of Business Full Time

Part Time

Seasonal

Present or last title


Part Time

Seasonal



Part Time

Seasonal



Part Time

Seasonal



Part Time

Seasonal



Part Time

Seasonal


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