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City of Campbell
Human Resources Division
70 North First Street
Campbell, California 95008-1423
408-866-2122
www.cityofcampbell.com
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.:
City: State/Zip:
Cell Phone: Alternate Phone: Work Phone:
E-mail Address:
Driver’s License Number: Driver’s License State: Driver’s License Class:
Are you over the age of 18? No
If answered YES on the previous question, please provide name and relationship:
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.
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.”
If hired, can you provide evidence of your legal right to work in the USA?
No
Do you have any relatives employed by the City or who are now on City Council, a City Board or Commission? Yes
] No
Have you ever been employed by the City of Campbell?
Yes
No
Are you able to perform the essential job functions for which you are applying, either with or without accommodation? Yes No
[
]
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)?
No
App MMQ
App
DNMQ
Late
Incomplete
Other
Letter
Invite
Human Resources Use Only
Yes
No If under 18, can you, after employment, submit a work permit?
Yes
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EDUCATION:
Did you graduate from high school or do you possess a GED?
Yes
No If no, highest grade completed or will be
within the next 4 months?
Did you graduate from college? [ ] Yes [ ] No
Qualifications, Skills, Certificates & Licenses: (Attach additional pages if necessary)
Please describe any experience you may have in working or volunteering with groups in a recreational setting (i.e. Community Centers,
Camps, After School Programs, Social Clubs, etc).
Please describe fully any job-related skills, knowledge, special training, certificates or licenses you may possess.
Software Applications (include typing WPM):
List any award(s), publication(s), qualifications for the position, etc. which are not listed in another area of the application.
Names and
Location of
School(s)
Attended
Major Area of Study
Units Completed
(Indication “S” for
semester and “Q”
for quarter)
Diploma/Degree
Attained
Date
Completed (Not
Applicable for
High School)
Did you Graduate?
[ ] Yes [ ]
No
[ ] Yes [ ]
No
[ ] Yes [ ]
No
[
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Experience: Do not indicate “SEE RESUME”- this section must be completed. List your work experience for the last 10 years
beginning with your current or most recent experience. Experience beyond 10 years ago should be included only if it
is directly related to the position for which you are applying. Use additional sheets if necessary.
Name of Employer: Job Title:
Supervisor’s Name/Phone #: # of Employees Supervised
Street Address: City: State/Zip
From (Mo./Yr.): To (Mo./Yr.): Hours per week:
Describe Below the Duties Performed:
Reason for Leaving:
Experience (continued):
Name of Employer:
Job Title:
Supervisor’s Name/Phone #:
# of Employees Supervised
Street Address:
City:
State/Zip
From (Mo./Yr.):
To (Mo./Yr.):
Hours per week:
Describe Below the Duties Performed:
Reason for Leaving:
May we contact your present employer regarding your qualifications and work record? ]Yes
No
Experience (continued):
Name of Employer: Job Title:
Supervisor’s Name/Phone #: # of Employees Supervised
Street Address: City: State/Zip
From (Mo./Yr.): To (Mo./Yr.): Hours per week:
Describe Below the Duties Performed:
Reason for Leaving:
Experience (continued):
Name of Employer: Job Title:
Supervisor’s Name/Phone #: # of Employees Supervised
Street Address: City: State/Zip
From (Mo./Yr.): To (Mo./Yr.): Hours per week:
Describe Below the Duties Performed:
Reason for Leaving:
CERTIFICATE OF APPLICANT (read carefully before signing)
I hereby certify that all answers stated in this application are true and I agree and understand that any misstatement of material fact
contained in the application will cause forfeiture upon my part of all rights of any employment in the service of the City of Campbell. I
have read the job bulletin for this position and believe that I meet all of the requirements.
SIGNATURE: DATE:
CITY OF CAMPBELL
Human Resources Division
70 North First Street
Campbell, CA 95008-1423
408-866-2122
www.cityofcampbell.com
VOLUNTARY
SELF-IDENTIFICATION
FORM
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 City of Campbell in
conducting research and in compiling statistical reports regarding the composition of its job applicants and
work forces. It is illegal to use this information to discriminate against, or give preference to, a person for
hiring or partition. This form will be separated from your application before the screening process and will
be kept confidential.
APPLICANT’S NAME DATE
POSITION APPLIED FOR
Please Check One: MALE FEMALE
Please Check One Box Below:
Asian or Pacific
Islander
All person having origins in any of the original peoples of the Far East,
Southeast Asia, the Indian Subcontinent, or the Pacific Islands
African
American or Black
All persons having origins in any of the Black racial groups of Africa (not of
Hispanic origin)
Hispanic
All persons of Mexican, Puerto Rican, Cuban, Central or South America, or
other Spanish culture origin, regardless of race
Native American or
Alaskan 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
White
All persons having origins in any of the original peoples of Europe, North
Africa or the Middle East (not of Hispanic origin)
Two or more races
All persons having origins in more than one race/ ethnic category
Other
How did you first hear of this position?
Friend or relative
calopps.org
City of Campbell employee
Indeed.com
City website
Other
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