No
-
No
No
1 2 3 4 5 6 7 8 9 10 11 12
wpm
No
No
Are you related to any person employed by the City of Farmersville?
No
Were you ever discharged (fired) or forced to resign from any positions? No
DEPARTMENT USE ONLY
CITY OF FARMERSVILLE
909 W. VISALIA ROAD
FARMERSVILLE, CA 93223
Ph. (559) 747-0458 Fx. (559) 747-6724
PLEASE PRINT WITH BLUE INK OR TYPE
www.cityoffarmersville-ca.gov
RECEIVED:
ACCEPT:
LATE:
INTERVIEW DATE:
Yes
Expiration Date
Address:
Position applying for: Date:
NO:
Street
Zip
City
Home Phone
Cell Phone
Other Phone
Have you ever worked for the City of Farmersville?
Yes
Are you a citizen of the United States?
Name
Middle
Last
Social Security Number
If not, Do you have a work permit from the U.S. Immigration and Naturalization Service?
Yes
Department:
Yes
Full Time
Part Time
Temporary
Seasonal
Volunteer
Type of Employment Desired?
Permit Number:
(Proof Required)
If YES to the above question, please list the dates.
EDUCATION
College or University
Type of School
High School
Graduate School
Name of School
City
Years Completed
Degree.Certification
Yes
Yes
No
High School Graduate?
Driver's License Number
State Issued:
Business School
Yes
If YES, please explain:
Has your Driver's License ever been Suspended or Revoked?
Trade School
NOTE: A conviction does not necessarily bar employment. Each case shall be given individual consideration.
If YES, please explain:
Yes
Have you ever been convicted of any violation of law? (excluding traffic tickets)
High School Equivalency?
If NO, check the highest year completed?
Professional License or
Certificate
Expiration Date
Type
Certificate #
Typing Speed
Computer
Office Skills:
Shorthand
Microsoft Office
Yes
If YES, please explain:
Name
Relationship
Department
to
Zip:
Salary:
to
Zip:
Salary:
to
Zip:
Salary:
to
Zip:
Salary:
Signature Date
Starting with the most recent or present experience, please provide the following information for all employment during the past 10 years. You may attach
a resume or a supplemental sheet to include add ional information, but this section must be completed. Include military service and volunteer employment
if applicable.
Employer: From:
CITY OF FARMERSVILLE
APPLICATION FOR EMPLOYMENT
EMPLOYMENT HISTORY
Job Title: Job Duties:
start
Address: City:
Telephone:
Address: City:
Telephone:
Reason for leaving:
Employer: From:
Reason for leaving:
Employer: From:
Job Title: Job Duties:
start
Job Title: Job Duties:
start
Address: City:
Telephone:
Address: City:
Telephone:
Reason for leaving:
Employer: From:
ending
ending
ending
Reason for leaving:
CERTIFICATION OF APPLICANT
(Carefully read before signing)
I certify that all statements made in this application and attachments are true and complete to the best of my knowledge and that any
misstatement of material fact may subject me to disqualification or dismissal. I also agree to allow the City of Farmersville to determine my
competence for certain positions in the fire or police departments or in departments where funds are involved, by obtaining credit, criminal and
other job related information about me. I also understand that if such checks are involved, I may be informed of their contents by submitting a
written request and that I have the right to respond to any finding which I believe to be incorrect.
Job Title: Job Duties:
start ending
CITY OF FARMERSVILLE
APPLICATION FOR EMPLOYMENT
SUPPLEMENTAL QUESTIONAIRE
ETHNIC CATEGORY:
ASIAN
The category "Asian" includes Asian-Americans and persons of Japanese, Chinese, Korean, Pacific
Islanders and Vietnamese descent.
BLACK
The category "Black" includes Blacks, African-Americans, persons of Jamaican, Trinidadian and
West Indian descents.
FILIPINO
The category "Filipino" includes all Filipino ancestry or ethnic origin.
The information requested below will be used for statistical purposes only. It will enable the Human Resources Division to evaluate City selection
processes for compliance with the federal and state equal employment opportunity laws. This information is requested on a voluntary basis and will not be
retained as part of your application. If you have any questions regarding this request, please contact the Human Resources Division. Your application will
be processed whether or not you complete these questions. Thank you for your assistance.
Name:
Your sex:
Male
(Please specify)
JOB SOURCE INFORMATION:
Please indicate where you learned of this job vacancy:
Interest Card Received/Walk-in to Human Resources Division
HISPANIC
The category "Hispanic" includes Mexican, Chicano, Latino, and all persons of Puerto Rican,
Cuban, Central or South American or Spanish ancestry or ethnic origin.
NATIVE AMERICAN
The category "Native American" includes persons who identify themselves as an American
Indian, or are known as such, by virtue of tribal associations, including Alaskan Native.
The category "White" includes Caucasians, Anglo-Saxons, Europeans, and persons of Indo-European,
North African or Middle Eastern ancestry or ethnic origin.
State Employment Office
Professional Journal or Publication (Please specify)
College Placement Service
Friend or Relative
Other (Please specify)
Newspaper (Please specify)
City of Farmersville web site
Internet bulletin board (Please specify)
Job Flyer Posted at Another Agency
Chrome Web Store
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