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Application must be completed in ink or typewritten
Application for Employment
1. Name (print)
Last
First
Middle
,
2. Position applying for (Show exact title – Separate application required for each examination)
Equal Opportunity Employer
Personnel Department
Human Resources Division
2600 Fresno Street, First Floor
Fresno, California 93721-3614
Phone (559) 621-6950
3. Mailing Address
No. and Street or P.O. Box No.
Apt. No.
Application Acceptance Policy
A complete application is required for each exam. Every applicable blank must be filled to insure proper evaluation. In item #5, do not refer to resumes or previously submitted applications.
Resumes are viewed as additional information and will not be used to evaluate minimum requirements.
DEPARTMENT USE ONLY
Received by
Veterans
Credit
City and State
Zip Code
Approved by
Rejected by
Reason
4. *Social Security No.
Home Phone:
Notices Mailed
*Use of your Social Security Number is voluntary.
Social Security numbers are used for identification purposes only. If you do not wish to use your Social Security number we will assign you an identification number.
Alternate Phone:
E-mail:
Grade
List #
5. Applicable Experience – List your current or most recent position first.
Hours worked per week
A
From
Month / Day / Yr.
To
Month / Day / Yr.
Your Job Title:
Employer’s Name, Address and Telephone No.
Your Duties:
Salary
Reason for Leaving:
Hours worked per week
B
From
Month / Day / Yr.
To
Month / Day / Yr.
Your Job Title:
Employer’s Name, Address and Telephone No.
Your Duties:
Salary
Reason for Leaving:
Hours worked per week
C
From
Month / Day / Yr.
To
Month / Day / Yr.
Your Job Title:
Employer’s Name, Address and Telephone No.
Your Duties:
Salary
Reason for Leaving:
Hours worked per week
D
From
Month / Day / Yr.
To
Month / Day / Yr.
Your Job Title:
Employer’s Name, Address and Telephone No.
Your Duties:
Salary
Reason for Leaving:
Hours worked per week
E
From
Month / Day / Yr.
To
Month / Day / Yr.
Your Job Title:
Employer’s Name, Address and Telephone No.
Your Duties:
Salary
Reason for Leaving:
SEE REVERSE SIDE – USE ADDITIONAL SHEETS IF NECESSARY
6.
Have you ever been convicted or declared guilty of a misdemeanor or felony
by any court?
If YES, give details in item 16. Conviction is not necessarily disqualifying. Each case will be evaluated on its own merits and its applicability to this position.
FAILURE TO DISCLOSE THIS INFORMATION WILL BE CAUSE FOR DISQUALIFICATION, REMOVAL FROM LIST OR DISCHARGE FROM EMPLOYMENT.
You May Omit:
A. Traffic violations for which the fine imposed was $100 or less.
(Any Traffic violations over $100 must be shown.)
B. Any offense committed prior to your 18th birthday which was finally adjudicated in
a juvenile court or under a youth offender law.
C. Any incident that has been sealed under Welfare and Institutions Code Section 781
Or Penal Code Section 1203 45.
(If appointed, your fingerprints will be taken for a criminal history check.
Certain positions may require a driving record check.)
Yes No
11.
Selective Service Registration. Federal Law requires male U.S. citizens and aliens residing
in the U.S. who are ages 18 through 25 to register with the Selective Service System.
A. I have registered with the Selective Services System. My Selective Service Number is
(A copy of your Selective Service confirmation MUST be attached.)
B. I am not required to register with the Selective Service System because I am exempt under the stated
age/gender requirements.
Yes No
12.
Did you graduate from High School, pass the State High School Equivalency
Exam, or do you possess a G.E.D. High School level Certificate?
A. Name of High School
B. Location of School
13.
Colleges and Schools attended after high school.
Name and Location
Major
Total Units or Hours
Degrees Received
7.
Have you ever been terminated from any employment or ever forced to resign?
If YES, give details in item 16.
Yes No
8.
Are you now or have you ever been employed by the City of Fresno.
If YES, give details in item 16.
Yes No
14.
Driver’s Lic. No.
Expires
9.
Are you related by blood or marriage to any person presently employed by the City of Fresno?
If Yes, give name, relationship, and department in which employed.
Yes No
Completion of this question is required only if the position for which you are applying requires the possession of a valid California Driver’s License.
15.
If you possess any license or certificate, give the following information:
Yes No
10.
Do you wish to apply for veterans credits?
A. Title
If Yes, acceptable documentary proof of U.S. military service For DD214 must be submitted with this application during the filing period.
B. License No.
Issuing State
Date Issued
Date Expires
Additional Remarks: (Attach extra sheet if necessary)
17.
We want to know how you heard about this position you are applying for:
Bulletin Board (Lobby)
Job line
Job Announcement
Friend or Relative
Newspaper: which one?
Internet: which web site?
Radio: which station?
Other, please specify
CERTIFICATE OF APPLICANT (Read this statement carefully before signing): I hereby certify that all statements made on or in connection with this application, including those regarding
my training, education and experience are true and complete to the best of my knowledge and belief, and I understand and agree that any misstatements or omissions of material fact herein
will cause forfeiture on my part of all rights to employment by the City of Fresno.
Your Signature
Date