Employment Experience

Health Department

Cherokee County, Texas

593 North Main Street

Rusk, Texas 75785

Telephone: (903) 683-4688

FAX:  (903) 683-4899

   

  Start  with  your  present  or  last  job.   Include any job-related military service assignments

 and volunteer activities.  You may exclude organizations which indicate race, color, religion,

 or gender, national origin, disabilities or other protected status.

 1.   Employer

Dates

Employed

Work Performed
 

From

To
    Address      
 
    Telephone Number(s)

Hourly Rate/

 Salary  
   

Starting

Final

  
    Job Title   Supervisor      
           
    Reason for Leaving      
         
 2.   Employer

Dates

Employed

Work Performed
 

From

To
    Address      
 
    Telephone Number(s)

Hourly Rate/

 Salary  
   

Starting

Final

  
    Job Title   Supervisor      
           
    Reason for Leaving      
         
 3.   Employer

Dates

Employed

Work Performed
 

From

To
    Address      
 
    Telephone Number(s)

Hourly Rate/

 Salary  
   

Starting

Final

  
    Job Title   Supervisor      
           
    Reason for Leaving      
         
 4.  Employer

Dates

Employed

Work Performed
 

From

To
    Address      
 
    Telephone Number(s)

Hourly Rate/

 Salary  
   

Starting

Final

  
    Job Title   Supervisor      
           
    Reason for Leaving      
         

 If you need additional space, please continue on a separate sheet of paper.

  List professional, trade, business or civic activities and offices held:

   You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry,

   disability or other protected status:
 
 
 
 
© 2006 Cherokee County Texas Health Department, Online Directory of Texas, Inc. and its licensors.     Application For Employment       Page 3 of  5 Pages