United States Shasta
Resume:
Return completed application to:
City of Shasta Lake
Personnel Department
P.O. Box 777
Shasta Lake, CA 96019
******@****************.***
Position Applied For: Expected Rate of Pay:open
Name:John Anthony Dominguez
LAST FIRST MI
Address:
STREET CITY STATE 21P
Mailing Address:
STREET STATE 21P
Home Phone No.: -
CITY
Mobile Phone No.: -
AREA CODE NUMBER AREACOOE NUMBER
Yes No
If you are hired, can you submit proof of right to work in the United States? Are you at least 18 years of age?
Have you been discharged or forced to resign a position? (If yes, please explain circumstances below.) Were you previously employed by the City of Shasta Lake? (List under what name and year below.) Do you have any relatives working for the City of Shasta Lake? (List names, relationship and department below.) Do you possess any license, permit, certificates or any other experiences, skills or qualifications which you feel would especially meet the requirements as stated on the job announcement?
Describe:
PERSONNEL DEPARTMENT ONLY
Application Received by:
Initial
Date
EMPLOYMENT APPLICATION
This Institution is an Equal Opportunity Employer
Incomplete information could disqualify you from
further consideration. Please complete all fields. Application must be typed or printed and signed in ink. Use black or dark blue ink.
DO NOT USE PENCIL.
Email Address:
School Name and Address of School Course of Study
Credits Earned
Diploma or Degree Grade Point
Quarter Average
Units
Semester
Units
High
College
Other
(Specify)
Business
Trade, etc.
THE CITY OF SHASTA LAKE IS AN EQUAL OPPORTUNITY EMPLOYER. THE CITY DOES NOT DISCRIMINATE IN EMPLOYMENT ON ACCOUNT OF RACE, COLOR, RELIGION, NATIONAL ORIGIN, CITIZENSHIP STATUS, ANCESTRY, AGE, SEX (INCLUDING SEXUAL HARASSMENT), SEXUAL ORIENTATION, MARITAL STATUS, PHYSICAL OR MENTAL DISABILITY, MILITARY STATUS OR UNFAVORABLE DISCHARGE FROM MILITARY SERVICE. I HEREBY CERTIFY THAT ALL STATEMENTS MADE IN THIS APPLICATION AND ACCOMPANYING MATERIALS ARE COMPLETE, ACCURATE AND TRUE TO THE BEST OF MY KNOWLEDGE. I AGREE AND UNDERSTAND THAT ANY OMISSIONS OR MISSTATEMENTS OF MATERIAL FACTS CONTAINED IN THE APPLICATION MAY CAUSE ME TO FORFEIT ALL RIGHTS TO EMPLOYMENT WITH THE CITY OF SHASTA LAKE. I UNDERSTAND THAT THE INFORMATION PROVIDED BY ME WILL BE VERIFIED. I AUTHORIZE THE RELEASE OF PERTINENT INFORMATION TO THE CITY BY EMPLOYERS AND EDUCATIONAL FACILITIES. THIS APPLICATION WILL BE GOOD FOR 180 DAYS. Signature of Applicant_ (Use ink, required for __application to _be __completed) Date If you are attaching a resume, please read: In order for your application to be considered, the following section MUST be completed. A resume MAY be attached, but WILL NOT be acceptable in lieu of this section. List below all present and past employment FOR THE LAST 10 YEARS beginning with your most recent. Explain gaps between employment periods. If more space is needed, use a separate sheet prepared in the same format and attach securely. Incomplete information MAY result in disqualification. DATES
Month-Year PRESENT
OR
LAST
POSITION
Company Position held
From Mailing address Your supervisor's name and title To City State Zip Code Reason for leaving Phone No. May we
contact?__Yes
__No
Your Duties Hours per week
DATES
Month-Year
NEXT
PREVIOUS
POSITION
Company Position held
From Mailing address Your supervisor's name and title To City State Zip Code Reason for leaving Phone No. May we
contact?__Yes
__No
Your duties Hours per week
DATES
Month-Year
NEXT
PREVIOUS
POSITION
Company Position held
From Mailing address Your supervisor's name and title To City State Zip Code Reason for leaving Phone No. May we
contact?__Yes
__No
Your duties Hours per week
DATES
Month-Year
NEXT
PREVIOUS
POSITION
Company Position held
From Mailing address Your supervisor's name and title To City State Zip Code Reason for leaving Phone No. May we
contact?__Yes
__No
Your duties Hours per week
Contact this candidate