Fillable EMPLOYMENT APPLICATION Town of Los Gatos (Town of Los Gatos)

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EMPLOYMENT APPLICATION Town of Los Gatos (Town of Los Gatos)

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EMPLOYMENT APPLICATION
Town of Los Gatos
110 E. Main Street
Los Gatos, CA 95030
www.losgatosca.gov
Please follow all application instructions carefully.
This application is part of the selection process. Print all answers accurately
and legibly in dark ink. Provide all information requested. Failure to list the
related experience required will be considered an incomplete application and
subject to rejection. Documents submitted with this application will not be
returned. Resumes will not substitute for the information required. For
additional space, attach extra sheets.
TITLE OF POSITION to which you are applying:
Last Name First Name Middle Name
Address City State Zip Code
CONTACT
Phone Number Email
DRIVER’S LICENSE –
License Number State Expires Class
If an asterisk (*) follows a question, explain any “yes” answers in the box. YES NO
1. If you are under the age of 18, can you submit a work permit after an offer of employment has been made?
(Do not answer this question if you are over 18 years of age.)
2. Can you submit verification of your U.S. citizenship or your legal right to work in the USA?
3. Do you have any relatives employed by the Town of Los Gatos?(*)
4. Are you currently a member or related to a current member of the Los Gatos Town Council or any other
Board or Commission?(*)
5. Have you ever been discharged or requested to resign from any position for misconduct or unsatisfactory
service?(*)
Explain any “YES” answers to questions marked with an asterisk (*). If necessary, make additional comments on a separate sheet of paper.
EDUCATION Check the highest year completed
Did not complete High School/GED High School/GED Some College AA/AS BA/BS Masters+
List your education/training related to the position including Colleges, Technical Schools, Military Schools, etc.
SCHOOL NAME
CITY/STATE OF SCHOOL
DEGREE
MAJOR/CERTIFICATE/OTHER
List special skills and currently valid licenses, certificates or registrations relevant to this position
APPLICANT NAME
QUALIFYING EXPERIENCE List experience which relates to the qualification as required on the Job Announcement.
Begin with your most recent experience. List all jobs separately. Resumes may be included, but do not write “See Resume” in lieu of completing the application.
Include all paid and unpaid experience which you believe may qualify you for the position.
NOTE: Qualifying experience is based on 40 hours per week (experience is pro-rated if less than 40 hours per week.)
Dates employed
From (mm/yyyy)
To (mm/yyyy)
Last Monthly Salary
Hours Per Week
Employer Name / City and State
Your Title:
Supervisor Name:
Supervisor Title:
Supervisor Phone:
Reason for leaving:
Dates employed
From (mm/yyyy)
To (mm/yyyy)
Last Monthly Salary
Hours Per Week
Employer Name / City and State
Your Title:
Supervisor Name:
Supervisor Title:
Supervisor Phone:
Reason for leaving:
Dates employed
From (mm/yyyy)
To (mm/yyyy)
Last Monthly Salary
Hours Per Week
Employer Name / City and State
Your Title:
Supervisor Name:
Supervisor Title:
Supervisor Phone:
Reason for leaving:
Dates employed
From (mm/yyyy)
To (mm/yyyy)
Last Monthly Salary
Hours Per Week
Employer Name / City and State
Your Title:
Supervisor Name:
Supervisor Title:
Supervisor Phone:
Reason for leaving:
Dates employed
From (mm/yyyy)
To (mm/yyyy)
Last Monthly Salary
Hours Per Week
Employer Name / City and State
Your Title:
Supervisor Name:
Supervisor Title:
Supervisor Phone:
Reason for leaving:
I certify that all statements I have made on this application and on all other supplemental material submitted with this application are true and correct. I hereby
authorize the Town of Los Gatos to investigate the accuracy of this information, and I release the Town of Los Gatos and all persons and organizations from all claims
and liabilities arising from such investigations or the supplying of information for such investigations. I acknowledge that any false statements or misrepresentations
will be cause for refusal to hire or for immediate dismissal at any time during the period of my employment. I understand that if I am hired, I will be required to take an
Oath of Office. I also understand that I may be required to pass an alcohol and drug test, a medical exam, and/or other tests as mandated by Federal, State, or local
law, or by the administrative policy of the Town of Los Gatos.
SIGNATURE DATE
The Town of Los Gatos is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, applicants requiring accommodation for any part of
the recruitment process must notify the Human Resources Department in advance.
EMPLOYMENT APPLICATION
SUPPLEMENTAL INFORMATION
Town of Los Gatos
110 E. Main Street
Los Gatos, CA 95030
www.losgatosca.gov
Section 1233 of the California Government Code gives each applicant the
opportunity to voluntarily indicate his/her identification on an employment
application. This information will be used by the Town of Los Gatos in
conducting research and in compiling statistical reports regarding the
composition of it job applicant pool and workforce. It is illegal to use this
information to discriminate against, or give preference to, a person for hiring
or promotion. After this information has been recorded by the Human
Resources Department, it will be removed from the application prior to
review by hiring departments.
TITLE OF POSITION to which you are applying:
Please indicate your gender: Male Female
Please place an “X” to indicate your Race / Ethnic identity
Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish cultures, regardless of race.
American Indian or Alaska Native: All persons having origins in any of the original peoples of North America and who maintain cultural identification
through tribal affiliation or community recognition.
Asian American or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or
the Pacific Islands. This area includes, for example, China, Japan, Southeast Philippine Islands, and Samoa.
African American (not of Hispanic origin): All persons having origins in any of the Black racial groups of Africa.
White (not of Hispanic origin): All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
HOW DID YOU FIRST HEAR OF THIS POSITION?
1. On Line Resource:
Name of site
2. Human Resources Department
3. Print Advertisement
Name of publication
4. Job Fair
10. Referred by Employee
Name of Employee:
12. Other. Please list:
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EMPLOYMENT APPLICATION Town of Los Gatos (Town of Los Gatos)

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Completed 3 August 2020

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