City of Campbell
Human Resources Division
70 North First Street
Campbell, California 95008-1423
GENERAL EMPLOYMENT APPLICATION
PLEASE NOTE: 1. A separate application is required for each position.
2. Completed applications are required to be mailed or hand delivered to the HR Division.
3. Faxed or E-mailed Applications will not be accepted.
4. Keep the Human Resources Division informed of any change in address or phone number.
THE CITY OF CAMPBELL IS AN EQUAL OPPORTUNITY EMPLOYER
Position Applying for:
Last Name: First Name: MI:
Street Address: Apt. No.:
Cell Phone: Alternate Phone: Work Phone:
Driver’s License Number: Driver’s License State: Driver’s License Class:
Are you over the age of 18? [ ] Yes [ ] No If under 18, can you, after employment, submit a work permit? [ ] Yes [ ] No
If hired, can you provide evidence of your legal right to work in the USA? [ ] Yes [ ] No
Do you have any relatives employed by the City or who are now on City Council, a City Board or Commission? [ ] Yes [ ] No
If answered YES on the previous question, please provide name and relationship:
Have you ever been employed by the City of Campbell? [ ] Yes [ ] No
If answered YES on the previous question, please state when and in what position:
The City of Campbell complies with the Fair Employment and Housing Act (FEHA) and all other disability laws. We will consider
reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions, unless
accommodation would cause undue hardship.
Are you able to perform the essential job functions for which you are applying, either with or without accommodation? [ ] Yes [ ] No
If NO, please describe below the functions which you cannot perform:
Have you ever been terminated, forced to resign, or rejected during probation (other than layoff) from employment within the last 10
years? If so, please give name of the employer, dates of the employment and reasons below. If no, indicate “not applicable.”
Are you an active member (non-retiree) of the California Public Employees Retirement System (CalPERS)? [ ] Yes [ ] No
Are you a retired member of the California Public Employees Retirement System (CalPERS)? [ ] Yes [
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