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Texas State Board of Social Worker Examiners: Social Work Employment History

This document is an employment history form for social workers applying for licensure in Texas. It requests information about the applicant's job titles, dates of employment, supervisors, employers, typical weekly work hours, and duties for all positions where the primary responsibility was providing social work services. Applicants must provide this employment history and are advised that most of the information submitted is subject to public disclosure under Texas public records laws.

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Mia Jackson
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© Attribution Non-Commercial (BY-NC)
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36 views

Texas State Board of Social Worker Examiners: Social Work Employment History

This document is an employment history form for social workers applying for licensure in Texas. It requests information about the applicant's job titles, dates of employment, supervisors, employers, typical weekly work hours, and duties for all positions where the primary responsibility was providing social work services. Applicants must provide this employment history and are advised that most of the information submitted is subject to public disclosure under Texas public records laws.

Uploaded by

Mia Jackson
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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FORM I

TEXAS STATE BOARD OF SOCIAL WORKER EXAMINERS


SOCIAL WORK EMPLOYMENT HISTORY
Name of Applicant:_____________________________________________________________
Start with your current or most recent position and work back. Only list those
positions for which your primary duty was the provision of social work services.
Job Title _____________________________ Dates Employed: from _________to________ No.
Hrs./Week______
Name / Phone number of Your Supervisor: ___________________________ Supervisor's license
______________
Name of Employer/Agency: _____________________ Address of Employer
______________________________
Describe Your Duties: __________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
*

Job Title_____________________________ Dates Employed: from _________to________ No.


Hrs./Week______
Name / Phone number of Your Supervisor: ___________________________ Supervisor's license
______________
Name of Employer/Agency: _____________________ Address of Employer
______________________________
Describe Your Duties: __________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
*

Job Title_____________________________ Dates Employed: from _________to________ No.


Hrs./Week______
Name / Phone number of Your Supervisor: ___________________________ Supervisor's license
______________
Name of Employer/Agency: _____________________ Address of Employer
______________________________
Describe Your Duties: __________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

____________________________________________________________________________________________
*
*
*
*
*
*
*
Please attach additional pages, if needed.

Revised 4/18/07

With few exceptions, you have a right to request and be informed about information that
the State of Texas collects about you. You are entitled to receive and review the
information upon request. You also have the right to ask the state agency to correct any
information that is determined to be incorrect. Most information submitted to the board
is subject to disclosure under the Public Information Act. (Reference: Government Code,
Sections 522.021, 522.023, 559.003 and 559.004)

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