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Our Mission is to Enable and Empower Individuals and Families to Live Quality Lives. Brazoria and Galveston Counties' Community Mental Health, Mental Retardation and Recovery Services Center.
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Administrative Office:
123 Rosenberg, Ste. 6
Galveston, TX 77550
P.O. Box 2490,
Galveston, TX 77553
Phone: 409-763-2373,
             281-488-2839
Fax:     409-763-5538
24 Hour Crisis:
866-729-3848
 
Online Job Application
POSITION DESIRED & QUALIFICATION Positions I Qualify For: Position Applying For:     
Last Name: First Name: Middle Name: Email: Address: City: State: Zip:   PERSONAL INFORMATION Home Phone: Work Phone: Cell Phone: Ext: Social Security Number: Convictions(Check if yes): Conviction Description:
   

 
EDUCATIONAL INFORMATION Graduation from High School (GED): Name of High School: Colleges Attended: First Degree Earned: First Degree Date: Degree Speciality: Second Degree Earned: Second Degree Date Degree Speciality: Third Degree Date: Degree Speciality: Third Degree:   (Separate with a comma)     Other Degrees: Other Type of School: Other Training: Foreign Languages: Typing WPM: Sign Language: Related Experience: Special Certifications:
EMPLOYMENT INFORMATION Company Name: Address: Hire Date: Termination Date: Reason For Termination: Supervisor: Salary (Start - End) Job Duties Work Phone Number Add Another Employer





















REFERENCES Name of Reference: Name of Reference: Name of Reference: Address: Address: Address: Phone: Phone: Phone: Email Address: Email Address: Email Address:
 
PRE-EMPLOYMENT STATEMENT
I voluntarily give the Gulf Coast Center the right to make a thorough investigation of my past employment and activities and release from all liability or responsibility all persons, companies or corporations supplying such information.

I consent to taking the pre-employment drug screen and agree to comply with the Center's safety rules.

I further understand that any false answers or statements made by me on this application or any supplement thereto, or in connection with the above mentioned investigation, will be sufficient grounds for immediate discharge.

The Gulf Coast Center ia an equal opportunity - affirmative action employer and shall not discriminate against any employee or applicant for employment because of race, color, religion, sex, age, disability, marital status, or national origin unless based on a bona fide occupational qualification.
 










 


 
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