INFORMATION FOR APPLICANTS
Thank you for your interest in serving the Humboldt County Office of Education. Because your qualifications will be initially
determined on the basis of the information provided in the application, it is essential that this application form and all other
supporting documents be complete and accurate in every respect. Resumes and vitas will be accepted; however, a
thoroughly completed application form is required in order for you to be considered for the position. Therefore, do not use
the phrase “see resume” or similar in the application or you will be subject to disqualification from the screening process.
To assist you in this procedure, we are providing these additional instructions for preparing the enclosed application
materials:
1. Applications should be submitted only by persons who meet all of the required qualifications as indicated in the job
specifications. Please review a copy of the job description before preparing and submitting the application.
2. For the sake of clarity, every item should have either an entry or the word “none” or “not applicable.” It is recommended
that applicants use a typewriter (for hard copy) or a computer (for online form) in completing these forms.
3. Verification of technical skills or certificates of completion for training programs may be provided with application. In
some instances, providing current skills certificates will permit a waiver of competency tests otherwise required for
employment. Contact the Personnel Office if you have specific questions.
4. Letters of recommendation from prior employers, supervisors, and/or training instructors are desirable and should
accompany application if available and if they would assist in determining your overall qualifications for the position you
are seeking.
5. Illegible or incomplete applications will not be processed. Please use care when filling out this application form.
6. Be sure to check the position announcement to see if any additional information is required to be submitted in addition
to this application form. Completed application papers and confidential file must be filed with the Personnel Office no
later than the deadline shown on the announcement. Candidates are encouraged to return their applications as early
as possible
7. The following apply to the question about being convicted of a crime: a) A conviction includes a plea or verdict of guilty,
a finding of guilt by a court in a trial without a jury, or a conviction following a plea of nolo contendere; b) You may
exclude convictions for marijuana related offenses more than two years old; c) Expungement, discharge or other order
by a court under Section 1203.4 of the Penal Code does not relieve you of your obligation to report all other felony or
misdemeanor convictions on this application; d) State law requires all applicants prior to employment to be fingerprinted;
e) Although generally a conviction does not bar employment, state law prohibits employment of any person convicted
of certain sex and narcotic offenses and certain serious or violent felonies.
Completed application papers must be filed with the Personnel Office no later than the deadline shown on the
announcement. Candidates are encouraged to return their applications as early as possible.
Should you need any assistance in filling out this form, please contact the Personnel Department staff.
The Humboldt County Office of Education is proud to support
the principles of Equal Employment Opportunity and Affirmative Action and does not
illegally discriminate against applicants on any basis protected by law. For more
information on EEO/AA policies, please contact the Personnel Office.
P-3
HUMBOLDT COUNTY OFFICE OF EDUCATION
Classified Service Application Form
Note: Please read instructions prior to completing this form
Position Applied For:
Name:
Address:
Email:
Home Telephone:
Day Phone:
Cell Phone:
Have you previously worked for us? yes no If yes, when?
I prefer: Full-time Part-time Substitute
Days/Hours Desired (if on call):
Earliest Date Available
for Employment:
ALL SCHOOL EMPLOYEES ARE REQUIRED TO BE TESTED FOR TUBERCULOSIS AND MUST PRESENT EVIDENCE OF FREEDOM FROM THE DISEASE. SOME POSITIONS REQUIRE THAT
THE SUCCESSFUL APPLICANT PASS A PHYSICAL EXAMINATION BEFORE EMPLOYMENT, SOCIAL SECURITY CARD AND VERIFICATION OF EMPLOYMENT ELIGIBILITY WILL BE REQUIRED
AT TIME OF EMPLOYMENT. ALL PERSONS APPOINTED TO POSITIONS WITH THE OFFICE OF EDUCATION WILL BE FINGERPRINTED (Ed. Code Section 45125), and APPLICANTS UNDER 18
YEARS OF AGE WHO HAVE NOT COMPLETED HIGH SCHOOL OR ITS EQUIVALENT MUST PROVIDE A WORK PERMIT AND MUST RECEIVE CLEARANCE BEFORE EMPLOYMENT.
EDUCATION AND TRAINING
No. of years:
Did you graduate: yes no
No. of years:
Did you graduate: yes no
Course of Study:
Degree or Certificate:
No. of years:
Did you graduate: yes no
Course of Study:
Degree or Certificate:
No. of years:
Did you graduate: yes no
No. of years:
Did you graduate: yes no
Course of Study:
Degree or Certificate:
No. of years:
Did you graduate: yes no
Course of Study:
Degree or Certificate:
LICENSES/CERTIFICATES: List any licenses or certificates you possess that qualify you for the vacant position:
LANGUAGE FLUENCY: Languages you can read, speak or write if use of a language other than English is relevant to
the job for which you are making application:
Sign Language?
Type of Sign:
TECHNICAL SKILLS: (Mark if applicable to opening)
Keyboarding
yes no
Speed:
Skill Level: Beg. Int. Adv.
Word Processing or
other Computer Skills
yes no
Speed:
Skill Level: Beg. Int. Adv.
Specify software and/or equipment used previously:
If applying for an Instructional Aide position, you must pass the Paraprofessional Exam required
by the State
of California PRIOR to employment. Please indicate your present status in relation to this requirement:
Yes, I passed the Paraprofessional Exam on (date):
No, I have not passed the Paraprofessional Exam as of the date of this application.
EMPLOYMENT HISTORY
List all jobs and any periods of unemployment in the last ten years. Include any military service.
Current or Most Recent Employment
Your Position Title:
Full-Time Part-Time
Employer:
Employer’s Address:
Employment Dates: From:
To:
1.0 Major Duties (Submit supplemental information if more room is needed):
Reason for Leaving:
Immediate Supervisor:
Phone Number:
Former Employer
Your Position Title:
Full-Time Part-Time
Employer:
Employer’s Address:
Employment Dates: From:
To:
1.1 Major Duties (Submit supplemental information if more room is needed):
Reason for Leaving:
Immediate Supervisor:
Phone Number:
Former Employer
Your Position Title:
Full-Time Part-Time
Employer:
Employer’s Address:
Employment Dates: From:
To:
1.2 Major Duties (Submit supplemental information if more room is needed):
Reason for Leaving:
Immediate Supervisor:
Phone Number:
Former Employer
Your Position Title:
Full-Time Part-Time
Employer:
Employer’s Address:
Employment Dates: From:
To:
1.3 Major Duties (Submit supplemental information if more room is needed):
Reason for Leaving:
Immediate Supervisor:
Phone Number:
VOLUNTEER/NON-PAID EXPERIENCE: Describe any previous volunteer or non-paid service which is related
to the position(s) you are seeking or which made use of similar job skills. Specify nature of work performed,
organization and length of service.
REFERENCES: List five individuals who are best able to attest to your qualifications and overall candidacy for
employment
Name
Daytime Telephone
Current Position/Title
Company
Address Home Office
Describe relationship to you (example: supervisor, co-worker, friend, etc.)
Name
Daytime Telephone
Current Position/Title
Company
Address Home Office
Describe relationship to you (example: supervisor, co-worker, friend, etc.)
Name
Daytime Telephone
Current Position/Title
Company
Address Home Office
Describe relationship to you (example: supervisor, co-worker, friend, etc.)
Name
Daytime Telephone
Current Position/Title
Company
Address Home Office
Describe relationship to you (example: supervisor, co-worker, friend, etc.)
Name
Daytime Telephone
Current Position/Title
Company
Address Home Office
Describe relationship to you (example: supervisor, co-worker, friend, etc.)
Do you claim a Veteran’s preference? Yes No
If yes, appropriate documentation or service/discharge must accompany this application.
Have you ever been convicted of a felony?
(Read Instruction 7 on the Information for Applicants before answering this
question.)
Yes
No If yes, submit a separate confidential letter of explanation with application.
Have you been arrested for any felony or misdemeanor for which you are currently out on bail or on your own
recognizance? Yes No
I certify that I meet all the minimum requirements as specified in the position announcement and/or job description and that all
information contained in this application and in the supplementary material filed with it is true and accurate. I authorize the contact of
any present or former employer to verify any information pertaining to this application, and I release from liability any persons or other
organizations furnishing such information. I understand that any false statements or omissions of material facts on the application will
subject me to disqualification from the application process or dismissal if employed.
Date Signature
11/19/Per Forms/P-3 Classified App/Word
VOLUNTARY
SUPPLEMENTAL INFORMATION
REQUEST FORM
To All Applicants:
The law requires that we keep certain statistics on applicants for Afrmative Action
documentation. This information sheet is what we use to meet this requirement. However,
the information requested on this sheet is strictly voluntary, and it is used by us only in
ling state and federal reports. It is not considered in the screening or selection process
in any manner, as it is separated from the application form before the written screening
process is begun. Your name is not required on this form.
1. I prefer to be identied as (only one please) :
Asian
Black
Caucasian
Filipino
Hispanic
Native American
Other: Please Specify _________________________
2. Sex: Male Female Nonbinary
3. Date of Birth: _________________________
2018-12/PersonnelForms/P-1