Fillable Employment Application Rev 05 07 21 (Housing Authority of the County of Santa Cruz)

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Employment Application Rev 05 07 21 (Housing Authority of the County of Santa Cruz)

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  • 18 check-boxes
  • 142 other fields

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Name: ____________________________________
Position: __________________________________
Employment
Application
Phone: (831) 454-9455, Fax: (831) 469-3712,
TDD: (831) 475-1146
The Housing Authority of Santa Cruz County is an Equal Opportunity Employer
W
e may verify information presented on your application, resume and any supplementary material provided. You should ensure that
any paperwork you submit in support of your candidacy is accurate and complete. If you are unclear about certain details, provide
information to the best of your recollection or ability, and note on the application that this is an approximation. Please
proofread your
application to ensure all information is accurate, complete and consistent with your resume. We will not offer employment to anyone
(or will subsequently terminate the employment of) anyone who knowingly provides inaccurate information about his/her
background or experience. We conduct all employment-related activities without regard to race, color, sex, religion, age, national
origin, disability, veteran status, sexual orientation, or any other classification protected by applicable State or Federal employment
discrimination laws. We welcome diversity in the workplace.
Application for Employment
Please PRINT or TYPE all information
Personal Information
Name: Last First Middle Initial
Today’s Date:
Current Address: Street and Number City State Zip
Telephone:
Home (
)
Cell ( )
Business Telephone:
( )
Do you have a driver’s license now? (this requirement applies only
to positions where driving is
Yes
No required for job performance)
Do you speak any language other than English?
Yes
No If YES, which one(s)?
Will you accept temporary work?
Yes
No
Can you, upon employment, submit verification of
your legal right to work in the United States?
Yes
No
Are you of legal age to work?
Yes
No
When would you be available to begin
work?
Have you ever applied for employment at the Housing Authority?
Yes
No if yes, when and for what position? ____________________________________________________________________________
Education
Major/Degree
# of Years
Completed
Did You
Graduate?
GPA
High School or GED:
Yes No
Business/Trade/Technical:
Yes No
College:
Yes No
Graduate:
Yes No
Describe other job-related training completed:
Activities, honors, offices held that are job related:
Additional Data
List any special skills, professional associations, professional job related licenses, military or vocational experience, or other job-relevant activities: (omit
those which indicate race, religion, national origin, color, sex, age or disability)?
List PC software programs you have experience with:
Are you able to perform the essential functions of the position for which you are applying with or without reasonable accommodations?
Yes
No
Employment History Start with your present or most recent employer
Please list your complete employment history (up to eight positions), starting with your current or most recent employer. All fields must be completed,
even if you have provided us with a resume. All current and past compensation fields must be completed to the best of your knowledge. Do not
leave these fields blank. If you worked on multiple assignments under a single staffing agency, consulting firm, or equivalent, please list the firm as your
employer and include a separate page listing the assignments performed while with that firm (including company name, pay, and assignment duration). In
the space provided, please include any periods in which you were not employed and explain what you were doing. All information may be verified.
If
you
are
currently
unemployed,
account
for
the
time
since
your
most
recent
employment.
From
(mo/yr) To
(mo/yr)
Employer Name: May we Contact?
Yes
No
Current Position:
Address (street number): Dates Employed: Responsibilities:
City/State/Zip:
Telephone:
Supervisor:
Reason for Leaving:
Starting Job Title: Final Job Title:
Account
for
time
between
employment.
From
(mo/yr) To
(mo/yr)
Employer Name: May we Contact?
Yes
No
Current Position:
Address (street number): Dates Employed: Responsibilities:
City/State/Zip:
Telephone:
Supervisor:
Reason for Leaving:
Starting Job Title: Final Job Title:
Account
for
time
between
employment.
(mo/yr)
_____
To
(mo/yr)
____
Employer Name: May we Contact?
Yes
No
Current Position:
Address (street number): Dates Employed: Responsibilities:
City/State/Zip:
Telephone:
Supervisor:
Reason for Leaving:
Starting Job Title: Final Job Title:
Account
for
time
between
employment.
(mo/yr)
_____
To
(mo/yr)
____
Employer Name: May we Contact?
Yes
No
Current Position:
Address (street number): Dates Employed: Responsibilities:
City/State/Zip:
Telephone:
Supervisor:
Reason for Leaving:
Starting Job Title: Final Job Title:
Account
for
time
between
employment.
From
(mo/yr)
_____
To
(mo/yr)
____
Employer Name: May we Contact?
Yes
No
Current Position:
Address (street number): Dates Employed: Responsibilities:
City/State/Zip:
Telephone:
Supervisor:
Reason for Leaving:
Starting Job Title: Final Job Title:
Conditions for Employment
Please read the following carefully before signing.
1. The information that I have provided on this application is accurate and true to the best of my knowledge.
2. I understand that any misrepresentation or omission of a fact on my application, resume or during the interview or hiring process may result in the
r
efusal of employment or if employed, immediate termination of employment.
3. The persons, schools, current and prior employers (if approved by me in the Employment History section), and other organizations or employers
named in this application are authorized by me to verify the information I have provided and to provide Housing Authority with information that may
be requested by the Housing Authority to arrive at an employment decision. I am willing that a photocopy of this authorization be accepted with t
he
s
ame authority as the original. I hereby waive and release all persons, schools, current and prior employers and other organizations from
any
liability arising from the disclosure of any of the above information whether in writing or orally, and further waive and release the Housing Authority
from any liability arising from reliance on the aforementioned information or the use, publication, or retention of such information within the context of
its applicant review procedures.
4. I agree to protect confidential information of the Housing Authority, and of Housing Authority’s clients.
5. I will be able, if hired, to certify that I am authorized to work in the United States of America, and understand that in accordance with the Immigration
Reform and Control Act that I will be required to provide timely documentation of identity and employment eligibility.
6. I understand that the Housing Authority will not employ persons who use illegal drugs and/or abuse alcohol or legal drugs, and the Housing
Authority retains and exercises the right to screen from employment such individuals. In fact, I agree and consent that I may be required to take
a
p
re-employment drug test. Further, I agree to abide by the Housing Authority’s “Statement on Drug-free Workplace,” a copy of which will be
provided if I am employed by the Housing Authority.
7. In the event that I am employed, I agree to conform to Housing Authority’s rules and regulations.
Print Name:
Signature of Applicant:
Date:
How did you learn about this job opportunity?
Craigslist
SantaCruzJobs.com Website
Other: _______________________
References
Give names of 5 persons as per the following guidelines:
a. D
irect supervisory references are strongly desired. However, supervisory references may also
include persons to which you reported to indirectly.
b. Project Team Members, clients, external vendors, and other professional peers may be used if a
brief explanation of the working relationship is provided
c. Personal acquaintances, family members and other person not in a position to objectively
evaluate your performance may not be used.
Name E-mail Address Telephone Relationship
Housing Authority is an equal opportunity employer and any applicant requiring special accommodations in the application or selection process should
contact the Administrative Services Director at 454-9455.
Thank you for taking the time to complete our Employment Application.
120116 MD 10/23/19
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Employment Application Rev 05 07 21 (Housing Authority of the County of Santa Cruz)

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Completed 15 May 2021

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