THIS CANDIDATE IS NOT AUTHORIZED TO WORK

CANDIDATE MAY NOT BEGIN WORK UNTIL YOU RECEIVE EMAIL CLEARANCE FROM EMPLOYEE SERVICES

Student/GA/Non-Budgeted Initiate to Hire

� Employee Name _________________________________________

� Employee Email ________________________________________(email that student checks)

� Position Title __________________Pay Rate __________________Dept __________________ o If pay rate is above $11.50, VP approval must be attached

� Position Number (PIN) ______________ Proposed Date of hire __________________ o 5-7 business dates from date of receipt in Employee Services is recommendedo Candidate may not begin work until department receives email clearance from Employee Services

verifying compliance with Federal I-9, Employment Eligibility Verification

� Attach background forms

� Attach application or resume

� Attach copy of Photo ID and Social Security Card o Inform candidate that ORIGINAL documents MUST be presented at Orientation/Onboarding Session.

Details will be emailed to candidate.

� Employee’s Manager ___________________________Ext.__________________

� Department Contact ___________________________Ext.___________________

Questions? Contact Teresa Burdick X9913

Return to Employee Services Box T-0510

Workday Student & GA Hiring Process Overview � Create Position

o Costing Allocationo Outside approvals (Financial Aid, higher pay rate justification, etc.)

� Send HR COMPLETED Initiate to Hire o HR runs background checko HR creates system record

� Manager and Department Contact receive HR email indicating: o The student employee is ready to be hired as an existing pre-hire or create pre-hire

� Manager or Department Contact hires employee into Workday o IMPORTANT hire only as HR has indicated (pre-hire or create pre-hire)

� Routes through appropriate approvals o HR Partnero Managero Department Head (if needed)

� Manager or Department Contact receive inbox items for Cost Allocation o Routes through appropriate approvals

� HR completes Workday To-Do - background check info and Selective Service to employee record

� HR sends Student Employee email with instructions on logging onto Workday o Manager and Department Contact are cc’do Password reset instructions are included on the emailo Employment is NOT authorized

� Student Employee completes ALL tasks in Inbox o HR sends email to student employee with orientation information and to bring original docs for Federal

I-9, Employment Eligibility Verificationo Manager and Department Contact are cc’d

� Student Employee attends orientation to furnish I-9, Employment Eligibility Verification original documents and to finalize I-9.

o Orientations are held Tuesday’s at 2pm and Friday’s at 9am in the Admin Annex I Conference Roomo GA Orientations are set at the beginning of each semester

� HR emails clearance for student employee to begin work to Manager and Department Contact

� Employment may begin. Employment Authorized

DEPARTMENT OF EMPLOYEE SERVICES Box T-0510 Stephenville, TX 76402 | Office (254) 968-9128 | Fax (254) 968-9590 | www.tarleton.edu/hr

Congratulations on your recent offer and we welcome you to Tarleton. To complete the employment process, a thorough background check will be conducted. All employment offers are contingent upon a satisfactory background check. The background check may be obtained from Federal, State, and local agencies, law enforcement agencies and/or in the form of a consumer report and/or an investigative consumer report. When the report is secured from a consumer reporting agency, the report is considered a consumer report.

A background check, consumer report and/or investigative consumer report containing information including, but not limited to, employment history, police record, education, qualifications, social security verification and/or motor vehicle records etc. may be obtained in connection with your application for and/or continued employment (including contract services) or volunteer services with Tarleton State University. In addition, a background check, consumer report and/or an investigative consumer report may be obtained at ANY time during the application process or during your employment or volunteering with Tarleton State University.

A consumer report containing injury and illness records and medical information and records may be obtained after a tentative offer of employment has been made. Credit history will not be obtained. Upon timely written request of the Employee Service/HR department of Tarleton State University, and within five (5) days of the request, the name, address and phone number of the reporting agency and the nature and scope of the investigative consumer report will be disclosed to you, if one was obtained.

Before any adverse action is taken, based in whole or in part on the information contained in the consumer report, you will be provided a copy of the report, the name, address and telephone number of the reporting agency, a summary of your rights under the Fair Credit Reporting Act, as well as additional information on your rights under the law.

Please print your name, sign and date this acknowledgement letter and return it along with the completed Background Check Disclosure Notice-Authorization Form to:

Tarleton State University Employee Services Box T-0510

Stephenville, TX 76402 Fax: 254-968-9590

Print your name

Signature Date

Background Check Authorization and Disclosure – July 2015

This form is used by the Employee Services Department as authorization to obtain criminal history information on the finalist candidate, as specified below.

--------------------------- TO BE COMPLETED BY THE APPLICANT-------------------------- Complete using Legal Name as Appears on

Last Name First Name Middle Name UIN (if available)

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

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

City County State Zip

Date of Birth* Social Security Number* Gender* Race* *To be used solely for the purpose of conducting a background check.

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 FOLLOWING QUESTIONS, ATTACH DETAILS ON A SEPARATE SHEET OF PAPER TO INCLUDE THE STATE, COUNTY, DATE OF OFFENSE, AND DETAILS.

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 FOLLOWING QUESTIONS, ATTACH DETAILS ON A SEPARATE SHEET OF PAPER TO INCLUDE THE STATE, COUNTY, DATE OF OFFENSE AND DETAILS.

1. Have you ever been convicted or plead guilty before a court for any federal, state or municipal criminal offense? YES NO (If yes, attach an extra page with the details including state, county, date of offense and details of the conviction.)

2. Have you ever received deferred adjudication or similar disposition for any federal, state or municipal offense? YES NO (If yes, attach an extra page with the details including state, county, date of offense and details of the disposition.)

3. Have you ever received pretrial diversion or similar disposition for any federal, state or municipal offense? YES NO (If yes, attach an extra page with the details including state, county, date of offense and details of the disposition.)

4. Have you ever received probation or community supervision for any federal, state or municipal offense? YES NO (If yes, attach an extra page with the details including state, county, date of offense and details of the disposition.)

5. Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States? YES NO (If yes, attach an extra page with the details including state, county, date of offense and details of the conviction.)

6. As of the date of this consent form, do you have any pending charges against you? YES NO (If yes, attach an extra page with the details including state, county, date of offense and details.)

In connection with my application for employment, my continued employment, or in connection with my desire to engage in volunteer activities, I have been advised and I hereby consent and authorize Tarleton 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 agree to release, indemnify and hold harmless Tarleton State University, any consumer reporting agency, any Federal, State, or local agency and any law enforcement agency used by Tarleton with regard 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.

BACKGROUND CHECK DISCLOSURE NOTICE AUTHORIZATION FORM

Background Check Authorization and Disclosure – July 2015

LIST ALL COUNTIES AND STATES OF RESIDENCE SINCE HIGH 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

(1) I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IN THIS BACKGROUND CHECK DISCLOSURE NOTICE ANDAUTHORIZATION FORM IS TRUE, CORRECT AND COMPLETE. I UNDERSTAND THAT INCORRECT OR INCOMPLETEINFORMATION MAY BE GROUNDS FOR TERMINATION OF CURRENT EMPLOYMENT OR CANCELLATION OF ANYAND ALL OFFERS OF EMPLOYMENT AT THE DISCRETION OF TARLETON 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 HAVE ATTACHED PAGES WITH DETAILS OF ARRESTS AND CONVICTIONS FOR ANY AND ALL “YES” RESPONSES TOQUESTIONS 1-6 ON THE FIRST PAGE.

SIGNATURE OF APPLICANT OR EMPLOYEE DATE

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

For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. If checked and you are a California applicant, a copy of consumer reports received on your behalf will be sent within three (3) days of Tarleton receiving a copy of the consumer report.

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- This form should be returned 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 form, please call 254-968-9128

Highest earned educational degree: Associate Bachelor’s Masters Doctorate

Field in which degree awarded:

Date degree conferred:

Name of institution granting highest degree:

Address of institution:

Your name while at institution (if different than current name):

DPS Computerized Criminal History (CCH) Verification

(AGENCY COPY)

I, , acknowledge that a Computerized Criminal APPLICANT or EMPLOYEE NAME (Please print)

History (CCH) check will be performed by accessing the Texas Department of Public Safety Secure

Website and will be based on name and DOB identifiers I supply. (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. 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 of 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.

(This copy must remain on file by your agency. Required for future DPS Audits)

Signature of Applicant or Employee

Date

Agency Name (Please print)

Agency Representative Name (Please print)

Signature of Agency Representative

Date

Rev. 09/2013

Please: Check and Initial each Applicable Space

CCH Report Printed:

YES NO initial

Purpose of CCH:

Empl Vol/Contractor initial

Date Printed: initial

Destroyed Date: initial

Retain in your files

Tarleton State University Employment Application

(Rev 4/2018)

Tarleton State University Employment Application Page 1 of 3

Pers

onal

Dat

a

Answer all applicable questions Date: Click here to enter a date. ☐ Full-Time ☐ Part-Time ☐ Nights ☐ Temporary

Name (Last, first, middle; other names previously used Social Security Number

Current address (Street & Number, or PO Box Home Phone

City, State, Zip Work Phone

Do you have a current, valid Driver’s License? If Yes DL# Type State

Do you have any relative working for TSU ☐ Yes ☐ No

If yes, list names, relationships and place employed:

Have you ever been employed by the State of Texas previously ☐ Yes ☐ No

If yes: When? Which agency?

Educ

atio

n

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 School

Graduated? Yes No

Number of semester hours completed

Type of diploma or degree

GPA Major field of study

High School

College or University

Technical/ Vocational

JOB

SKIL

LS

Computer Software & Competency:

☐ Microsoft Access ☐ Microsoft Excel☐ Microsoft Outlook☐ Microsoft PowerPoint☐ Microsoft Publisher☐ Microsoft Word ☐ Adobe Acrobat

☐ Typing _________WPM☐ Copier☐ Fax☐ Scanner☐ Printer

List Additional Skills:

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

Tarleton State University Employment Application

(Rev 4/2018)

Tarleton State University Employment Application Page 2 of 3

Empl

oym

ent

Employer: Telephone No. Mailing address City, State Zip Code

Type of Business Full Time ☐ Part Time ☐ Seasonal ☐

Start Date End Date Starting Salary Ending Salary Starting Title: Present or last title

Briefly describe duties & responsibilities (include supervisory experience)

Immediate Supervisor Reason for Leaving

Employer: Telephone No. Mailing address City, State Zip Code

Type of Business Full Time ☐ Part Time ☐ Seasonal ☐

Start Date End Date Starting Salary Ending Salary Starting Title: Present or last title

Briefly describe duties & responsibilities (include supervisory experience)

Immediate Supervisor Reason for Leaving

Empl

oym

ent

Employer: Telephone No. Mailing address City, State Zip Code

Type of Business Full Time ☐ Part Time ☐ Seasonal ☐

Start Date End Date Starting Salary Ending Salary Starting Title: Present or last title

Briefly describe duties & responsibilities (include supervisory experience)

Immediate Supervisor Reason for Leaving

Employer: Telephone No. Mailing address City, State Zip Code

Type of Business Full Time ☐ Part Time ☐ Seasonal ☐

Start Date End Date Starting Salary Ending Salary Starting Title: Present or last title

Briefly describe duties & responsibilities (include supervisory experience)

Immediate Supervisor Reason for Leaving

Empl

oym

ent

Employer: Telephone No. Mailing address City, State Zip Code

Type of Business Full Time ☐ Part Time ☐ Seasonal ☐

Start Date End Date Starting Salary Ending Salary Starting Title: Present or last title

Briefly describe duties & responsibilities (include supervisory experience)

Immediate Supervisor Reason for Leaving

Employer: Telephone No. Mailing address City, State Zip Code

Type of Business Full Time ☐ Part Time ☐ Seasonal ☐

Start Date End Date Starting Salary Ending Salary Starting Title: Present or last title

Briefly describe duties & responsibilities (include supervisory experience)

Immediate Supervisor Reason for Leaving

Tarleton State University Employment Application

(Rev 4/2018)

Tarleton State University Employment Application Page 3 of 3

Tarleton State University

I hereby certify that the foregoing statements as well as those on any attachment(s) to this form are to the best of my knowledge true and correct and that they are all given of my own free will. I agree that any intentional misstatement(s) or omission(s) as to material facts will constitute grounds for unfavorable consideration or dismissal from employment.

I authorize the schools, references and my prior employers listed in my employment application to provide my record, reason for leaving and all other information they may have concerning me. I understand a criminal history information check will be conducted for all positions, as all Tarleton positions are designated as security sensitive. I release all parties from any and all liability or claims for any damage whatsoever that may result from these actions.

I understand that this application and all attachments are the property of Tarleton State University. If I am hired, my employment is contingent upon furnishing required documents including transcripts, when necessary and presenting original documents necessary for verification of identity and employment eligibility in the United States.

________________________________________ Applicant Signature Date

Tarleton State University is an Equal Opportunity/Affirmative Action/Veterans/Disability Employer.

Tarleton State University participates in E-Verify. We will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee’s Form I-9 to confirm work authorization. If the Government cannot confirm that you are authorized to work, Tarleton will provide you written instructions and an opportunity to contact DHS and/or the SSA before taking adverse action against you, including terminating your employment. E-Verify will not be used to pre-screen job.

Males ages 18 through 25 show proof of compliance with federal Selective Service law in order to be eligible for employment with the state.

The Immigration Reform and Control Act of 1986 requires that within three Days of their employment, all new employees must present original documents verifying identity and right to accept employment within the United States.

__________________________ __________________

Voluntary Self-Identification of Disability

Form CC-305 OMB Control Number 1250-0005

Expires 1/31/2020Page 1 of 2

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

Blindness Deafness Cancer Diabetes Epilepsy

Autism Cerebral palsy HIV/AIDS Schizophrenia Muscular dystrophy

Bipolar disorder Major depression Multiple sclerosis (MS) Missing limbs or partially missing limbs

Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation)

Please check one of the boxes below:

☐ YES, I HAVE A DISABILITY (or previously had a disability)☐ NO, I DON’T HAVE A DISABILITY☐ I DON’T WISH TO ANSWER

Your Name Today’s Date

i

Voluntary Self-Identification of Disability

Form CC-305 OMB Control Number 1250-0005

Expires 1/31/2020Page 2 of 2

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Student Records Policies and ProceduresConfidentiality of Education Records

UNIVERSITY POLICY STATES THAT UNDER NO CIRCUMSTANCE SHOULD YOUR PASSWORD BE SHARED WITH OTHER EMPLOYEES OR STUDENT WORKERS!

1. GeneralThe Family Educational Rights and Privacy Act of 1974 is a federal law that grantsto students the right to inspect, to obtain copies, to challenge and, to a degree,control the release of information contained in his or her education records. Theact and regulations are very lengthy and for that reason Tarleton State Universityhas issued guidelines which are Available to students in the Office of the Dean ofStudents. Students are urged to acquaint themselves with the guidelines.

2. Directory InformationThe following Directory Information may be given out without the student’sconsent:

A. Personal DataIncludes students’ mailing address, all telephone numbers, emailand date of birth.

B. Enrollment DataIncludes students’ academic program (school of record, degreeobjectives, majors, minors, and anticipated date of graduation),classification, dates of attendance, degrees and awards received,and previous educational agency or institution(s) attended.

C. Athletic Participation DataIncludes participation in officially recognized activities and sports,and weight and height of members of athletic teams.

Items/data not designated directory information can only be released with the consent of the student or without the consent of the student in a few specific situations, such as dependent of parent.

Students have the right to limit and restrict the release of this information by notifying the Office of the Registrar. Requests for restriction of Directory Information items are to be filled out in person, on the appropriate form, within 10 days after the first class day.

3. Parental Certification of Student DependencyThe family Educational Rights and Privacy Act restricts Tarleton State Universityfrom releasing academic information to anyone, including parents, without thestudent’s permission to release such information. FERPA permits an exception tothis policy when the parents claim the student as a dependent on their income tothis policy when the parents claim the student as a dependent on their income taxform sunder the rules of section 152 of the Internal Revenue Code of 1954.Parents must complete a Parental Certification form in the Office of the Registrar,annually, to certify the dependency of their son or daughter and to be eligible toreceive academic information upon request.

4. Release of Information on CampusThe Act does allow release of information to faculty, staff and other students of theinstitution, but ONLY on a bona fide “need to know” basis. What constitutes a bonafide “need to know” can be unclear, and at times there can be differing interpretations.“Need to know” means that the information is needed for the staff, faculty, or studentto carry out their Tarleton function. It does not include “would like to know.” Theremust be a clear relationship between obtaining the information and the successfulmeeting of assigned Tarleton job responsibilities.

Each staff member is responsible to release information only upon the careful determination that the information is needed for a bona fide “need to know” reason and to request information for our use with a “need to know.”

The most common possible abuse of student information comes from employees or students who have family members, friends, or acquaintances as students.

“Need to Know” must be established prior to releasing any confidential information. Remember, that if it isn’t one of the Directory Information items, then it is CONFIDENTIAL. If in doubt, then DON’T release the information without consulting your supervisor.

Reports that contain confidential student information, anything that isn’t Directory Information, should have a cover memo and/or notation on the report stating that the information contained in the report is confidential, provided on a “Need to Know” basis, cannot be released to non-Tarleton State University persons and can only bereleased to other Tarleton State University persons on a “need to know” basis.

Tarleton State University, Student Records Policies and Procedures

Confidentiality of Education Records, continued.

CONFIDENTIALITY STATEMENT FOR FACULTY & STAFF EMPLOYEES

I, __________________________________________________ understand that by the virtue of my employment

with Tarleton State University, I may have access to records with contain individually identifiable information, the

disclosure of which is prohibited by the Family Educational Rights and Privacy Act of 1974 (FERPA). This information

is confidential and may not be divulged to anyone except the person who owns the information, those faculty/

staff/administrators who have a “legitimate educational need to know,” and those individuals/agencies (parents/

guardians who sign/file the Certification of Dependency form, the National Student Clearinghouse acting as an

agent of Tarleton State University, scholarship agencies or an embassy for example) who fulfill the requirements

under FERPA. Confidential information includes anything not defined as “directory information” by Tarleton State

University, as well as, directory information a student has put a hold on with the paper form.

I acknowledge that I fully understand that the intentional disclosure by me of this information to any unauthorized

person could subject me to criminal and civil penalties imposed by law. I further acknowledge that such willful or

unauthorized disclosure also violates the institution’s policy and could constitute just cause for disciplinary action

including termination of my employment, regardless of whether criminal or civil penalties are imposed.

I have read the above and agree to the requirements for confidentiality.

________________________________________ __________________________________ Name of User (Please Print) Signature of User

________________________________________ ___________________________________ UIN Department

*********************************************************************************

_________________________________________ _____________________________________ Accepted By Date