Correctional Officer Referral Form

Are you a TDCJ Employee? Yes No

TDCJ Employee Information

Your Payroll Name:

Current Position:

Your Phone: () -

Date of Birth (MM/DD) /

Unit/Department:

Your E-mail:

Your Information

Name:

Relationship to Referral:

Phone: () -

City:

State:

E-mail:

Referral Information

Referral Name:

Referral E-mail:

Referral Phone: () -

Employee Signature

I have referred the above named person for a correctional officer (CO) position with the Texas Department of Criminal Justice. I understand that I will receive a $100 gift card and eight hours of administrative leave for an applicant referral that results in a newly hired CO that completes 6 calendar months of employment. I acknowledge that the value of the gift card is considered taxable income and can choose from the following options: Gift Card:

Electronic Signature Agreement: By selecting the "I Accept" button and typing your name in the box provided below, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide the Texas Department of Criminal Justice (TDCJ) or in accessing or making any transaction regarding any agreement, acknowledgment, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and the TDCJ.

Text Check: leave this field blank:

I understand and accept the statements above

Re-Enter Your Name: Date: 12/03/2023

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