| City
of Hollister, Employment Application |
| (* Required field) |
| PERSONAL INFORMATION |
| *Position Applying
For: |
|
| *Full Name:
|
| *Last:
*First:
Middle:
|
| Mailing Address: |
| Street |
|
| City: |
|
| State: |
|
| Zip Code: |
|
| *Day Phone: |
|
| *Evening Phone: |
|
| *Are you over 18?
Yes
No |
| If No, can you submit
a work permit if hired?
Yes
No |
| Police Officer
applicants only: |
| Date of Birth: |
/
/
( MM / DD / YYYY ) |
| Driver's License Number: |
|
| State:
Expiration Date:
/
/
( MM / YYYY ) |
| Are you a U.S.
citizen or do you have the right to work permanently
in the U.S.?
Yes
No |
| Languages
you speak fluently other than English:
|
| Were
you referred to this job opening by a current
City of Hollister employee?
Yes
No |
| (if yes, state
whom): |
|
| Please
answer the following questions. "Yes"
answers are not necessarily disqualifying. |
| Have you
ever been convicted of any offense other than
a driving violation? If yes, list offense and
date under "Comments."
Yes
No |
| Comments: |
|
| Have you
ever been convicted of reckless driving or driving
under the influence of alcohol/drugs OR has your
driver's license ever been suspended or revoked?
If yes, list offense and conviction date under
"Comments."
Yes
No |
| Comments: |
|
| Were you
ever discharged from employment or forced to resign?
If yes, explain.
Yes
No |
|
|
| Are you
now or have you ever been employed by the City
of Hollister? Do you have a relative who is an
official or employee of the City of Hollister?
If yes, explain.
Yes
No |
|
|
| |
| EDUCATION |
| College/University: |
|
| Date Graduated: |
|
| Degree Received: |
|
| Major Subjects: |
|
| Sem.
Units:
Qtr. Units:
|
| High School: |
|
| Did you
graduate?
Yes
No
GED |
| |
| JOB
RELATED TRAINING |
| Describe
any job-related skills, knowledge, special training,
certificates or licenses you possess. |
|
|
| |
| WORK
EXPERIENCE |
| List your
most recent employment or related volunteer work
first and account for all time periods during
the last 10 years. List each change in title or
promotion separately. A resume will not
substitute for the information required in this
section. |
| Employer: |
|
| Address: |
|
| Title of Your Present
Position: |
|
| From: |
/
( MM / YYYY ) |
| To: |
/
( MM / YYYY ) |
| Total Time: |
|
| Hours per week: |
|
| Final Salary: |
|
| Number You Supervised: |
|
| Name of Supervisor
and Phone Number: |
| Name:
Phone Number:
|
| Duties: |
|
| Reason for Leaving: |
|
| |
| Employer: |
|
| Address: |
|
| Title of Your Present
Position: |
|
| From: |
/
( MM / YYYY ) |
| To: |
/
( MM / YYYY ) |
| Total Time: |
|
| Hours per week: |
|
| Final Salary: |
|
| Number You Supervised: |
|
| Name of Supervisor
and Phone Number: |
| Name:
Phone Number:
|
| Duties: |
|
| Reason for Leaving: |
|
| |
| Employer: |
|
| Address: |
|
| Title of Your Present
Position: |
|
| From: |
/
( MM / YYYY ) |
| To: |
/
( MM / YYYY ) |
| Total Time: |
|
| Hours per week: |
|
| Final Salary: |
|
| Number You Supervised: |
|
| Name of Supervisor
and Phone Number: |
| Name:
Phone Number:
|
| Duties: |
|
| Reason for Leaving: |
|
| |
| Please
paste a text-only copy of your resume here. |
|
|
| |
| CERTIFICATE
OF APPLICANT: I certify that the information
contained in this application for employment is
true and complete to the best of my knowledge.
I understand that any misrepresentation or deliberate
omission of a material fact in my application
may disqualify me from the application process
or terminate my employment. I agree to undergo
a physical examination by a City physician, including
drug testing, if offered employment. I further
agree to furnish proof of age, education, and
legal right to work in this country if required
as a condition of employment. I authorize the
employers, schools or persons named in my application
documents to give any additional information regarding
my qualifications and character, and release them
from any liability for any damages whatsoever
for issuing this information to the extent permitted
by law. |
| |
|
