East Texas Council On

Alcoholism And Drug Abuse

Mission Statement

Our Mission is to provide recovery support services and reduce substance use through education and intervention. We also help young adults successfully transition into adulthood by providing services to address essential needs.

Employment Application

PLEASE READ CAREFULLY
Note: Fields marked with a * require an answer. Please use "N/A" for "not applicable" if necessary. Applicants may be required to complete and sign a paper application for employment upon interview.

Attach Resume: (pdf, doc, docx)

*Email: Applying for:

Applicant Information

Education

If applying for a position as a Licensed Chemical Dependency Counselor, I am Licensed by the State of Texas as LCDC.

Select One: Yes No

If yes, where and when was LCDC training received?

High School:

HS Address:

Graduate: Yes No

Degree:

College:

College Address:

Graduate: Yes No Certificate Received

Degree: Certificate: Hours Completed:

Other:

Other Address:

Graduate: Yes No

Degree:

References

Please list the names of three (3) persons (other than relatives) who have a definite knowledge of your ability and character. Please give their present address and a daytime telephone number.

Name #1:

Address #1:

Day Phone Numbers #1:

Relationship #1:

Name #2:

Address #2:

Day Phone Numbers #2:

Relationship #2:

Name #3:

Address #3:

Day Phone Numbers #3:

Relationship #3:

Employment History

Company Name:

Complete Address
(w/ City, State, Zip):

Phone:

Supervisor:

Job Title:

Responsibilities:

Start Date:
(mm/dd/yyyy)

End Date:
(mm/dd/yyyy)

Reason for Leaving:

May we contact your previous employer for a reference? Yes No

Military Service

Start Date:
(mm/dd/yyyy)

End Date:
(mm/dd/yyyy)

Branch:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Applicant's Statement

Notification and Agreement

The information provided in this employment application is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal. I also understand that an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

Please print and sign all PDFs below. These will be required for us to proceed with your application.

Applicant Acknowledgement Application Disclosure Release Confidentiality Statement Consent to Obtain Criminal Background and Driving Record Drug and/or Alcohol Testing Consent Form Drug Free Workplace Policy Employee Consent for Pre-employment Drug-screen Consent Employment Reference Release

Please mail, scan and email, or bring these to our office.

Full Name:

Today's Date: