Job Application

(This is not a consent form). 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, therefore the organization conducting the criminal history check is not allowed to discuss with me any criminal history record information obtained using this method. I or the agency may request that I have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search. Once this process is completed the information on my fingerprint criminal history record may be discussed with me.
In order to complete the process, I must make an appointment with the Fingerprint Applicant Services in 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 $24.95 to the fingerprinting services company.

(1) an offense under Chapter 19, Penal Code (criminal homicide);
(2) an offense under Chapter 20, Penal Code (kidnapping, unlawful restraint, and smuggling of persons);
(3) an offense under Section 21.02, Penal Code (continuous sexual abuse of young child or children), or Section 21.11, Penal Code (indecency with a child);
(4) an offense under Section 22.011, Penal Code (sexual assault);
(5) an offense under Section 22.02, Penal Code (aggravated assault);
(6) an offense under Section 22.04, Penal Code (injury to a child, elderly individual, or disabled individual);
(7) an offense under Section 22.041, Penal Code (abandoning or endangering child);
(8) an offense under Section 22.08, Penal Code (aiding suicide);
(9) an offense under Section 25.031, Penal Code (agreement to abduct from custody);
(10) an offense under Section 25.08, Penal Code (sale or purchase of child);
(11) an offense under Section 28.02, Penal Code (arson);
(12) an offense under Section 29.02, Penal Code (robbery);
(13) an offense under Section 29.03, Penal Code (aggravated robbery);
(14) an offense under Section 21.08, Penal Code (indecent exposure);
(15) an offense under Section 21.12, Penal Code (improper relationship between educator and student);
(16) an offense under Section 21.15, Penal Code (improper photography or visual recording);
(17) an offense under Section 22.05, Penal Code (deadly conduct);
(18) an offense under Section 22.021, Penal Code (aggravated sexual assault);
(19) an offense under Section 22.07, Penal Code (terroristic threat);
(20) an offense under Section 32.53, Penal Code (exploitation of child, elderly individual, or disabled individual);
(21) an offense under Section 33.021, Penal Code (online solicitation of a minor);
(22) an offense under Section 34.02, Penal Code (money laundering);
(23) an offense under Section 35A.02, Penal Code (Medicaid fraud);
(24) an offense under Section 36.06, Penal Code (obstruction or retaliation);
(25) an offense under Section 42.09, Penal Code (cruelty to livestock animals), or under Section 42.092, Penal Code (cruelty to non-livestock animals); or
(26) a conviction under the laws of another state, federal law, or the Uniform Code of Military Justice for an offense containing elements that are substantially similar to the elements of an offense listed by this subsection.

(1) an offense under Section 22.01, Penal Code (assault), that is punishable as a Class A misdemeanor or as a felony;
(2) an offense under Section 30.02, Penal Code (burglary);
(3) an offense under Chapter 31, Penal Code (theft), that is punishable as a felony;
(4) an offense under Section 32.45, Penal Code (misapplication of fiduciary property or property of financial institution), that is punishable as a Class A misdemeanor or a felony;
(5) an offense under Section 32.46, Penal Code (securing execution of document by deception), that is punishable as a Class A misdemeanor or a felony;
(6) an offense under Section 37.12, Penal Code (false identification as peace officer; misrepresentation of property); or
(7) an offense under Section 42.01(a)(7), (8), or (9), Penal Code (disorderly conduct).

I understand that I cannot be employed if the criminal history results identify offenses that bar employment or if I am listed as unemployable as a result of the employee misconduct registry search or the nurse aide registry search. I understand that the agency will complete the searches of the EMR and the NAR on an annual basis for unlicensed staff with face-to-face client contact. The EMR rules are referenced at Title 40, Part 1, Chapter 93 [RULE §93.3] and Chapter 253, Texas Health and Safety Code, Employee Misconduct Registry.

I understand that if the agency believes that a conviction or other criminal history results may bar my employment or may be a contraindication to employment that I can be fingerprinted at my own cost and request my own the criminal history record as a way of verifying the accuracy of my criminal history record.

I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.
I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application.

In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees. In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required.

I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis.