CITY OF HUNTINGTON PARK EMPLOYMENT APPLICATION
HUMAN RESOURCES DEPARTMENT FOR THE POSITION OF:
6550 Miles Avenue
Huntington Park, CA 90255
Phone (323) 584-6227 24-Hour Job Hotline (323) 584-6209
www.hpca.gov
Applicant Instructions: Please read the recruitment announcement for the position desired. If you possess the qualifications for the job, show clearly on this application
all previous education, training and work experience which qualifies you for this position. Please print clearly in ink or type. Answer all questions accurately and
completely. All statements in your application are subject to verification and incorrect or incomplete statements may bar or remove you from employment. Read the
Certificate of Applicant in Section 6 carefully before signing.
1. PERSONAL DATA
Name (Last) ( First) (Middle)
Area Code Home Telephone Number
/
Other Names Used
Area Code Work Telephone Number
/
Home Address (Number and Street)
Area Code Cell Phone Number
/
(City, State & Zip)
E-mail Address
Do you have a valid California Driver’s License? YES NO
State: Number: Class: Expiration Date:
Social Security Number
Can you, after employment, submit proof of U.S. Citizenship or proof of permanent resident alien status? YES NO
Are you at least 18 years of age? YES NO
If no, can you submit a valid work permit? YES NO
Do you claim Veteran’s Preference? YES NO
If yes, proof of honorable discharge (DD214) from U.S. Armed Forces must be attached at time of application.
Will you accept part time work? YES NO
Will you accept temporary work? YES NO
Date of Birth: (Police Applicants only)
What languages, other than English, do you speak
fluently?
Personal References (List persons not related to you).
Phone Number
Occupation
2. EDUCATION AND TRAINING (Attach additional sheets if necessary)
Name and location of last grade or high school attended:
Completed (1-12)
Did you graduate?
YES NO
Do you have a GED Certificate?
YES NO
Name and location of Colleges, Universities, Business
or Trade Schools attended:
Number of Units
Completed
Sem
Qtr
Major Subjects
Degree or Certificate
You must attach a copy
Dates Received
or Expected
Please describe additional course work or training (including military) which would qualify you for this position.
Please list certificates or licenses of professional or vocational competence you possess which relate to this position.
Please describe any relevant skills you have such as computer skills (hardware and software), machine or equipment operation.
Have you ever been employed by the City of Huntington Park? YES NO
From _________________________ To ________________________ Department ______________________
The City has a Nepotism Policy which may preclude employment of certain family members of current employees of the City. Are you related to any present City
employee or elected official of the City of Huntington Park? YES NO If yes, please provide:
Relative’s name(s) ____________________________________ Relationship: ______________________________________
3. A “YES” ANSWER TO ANY OF THE NEXT 2 QUESTIONS REQUIRES AN EXPLANATION UNDER SECTION 4.
Please complete the section below only if you are applying for a Police Department position.
Have you at any time in your life been convicted or adjudicated, in other than a juvenile court, of a felony or misdemeanor other than minor traffic violations? YES NO
A criminal record does not constitute automatic bar to employment, but will be considered in terms of the work to be performed. Failure to disclose a criminal conviction
will result in termination. If yes, indicate below for each offense the (1) Date, (2) Offense, (3) Place, and (4) Action Taken.
Have you ever been discharged or requested or forced to resign from any position for misconduct or unsatisfactory service? YES NO
4. ADDITIONAL INFORMATION
Use this space to provide additional information as required by this application, or to describe in greater detail any aspects of your experience or activity that are pertinent to the
job you are seeking.
AN EQUAL OPPORTUNITY EMPLOYER
1
2
3
EMPLOYMENT HISTORY
READ CAREFULLY BEFORE BEGINNING THIS SECTION
Do you object to having your present employer contacted? Yes No If yes, explain
From: To:
Title of Your Position:
Mo. Yr. Mo. Yr.
Duties:
Name and Address of Employer:
Name of Supervisor:
No. Supervised (if any): Hours per Week:
Reason for Leaving:
Telephone Number of Employer:
From: To:
Title of Your Position:
Mo. Yr. Mo. Yr.
Duties:
Name and Address of Employer:
Name of Supervisor:
No. Supervised (if any): Hours per Week:
Reason for Leaving:
Telephone Number of Employer:
From: To:
Title of Your Position:
Mo. Yr. Mo. Yr.
Duties:
Name and Address of Employer:
Name of Supervisor:
No. Supervised (if any): Hours per Week:
Reason for Leaving:
Telephone Number of Employer:
From: To:
Title of Your Position:
Mo. Yr. Mo. Yr.
Duties:
Name and Address of Employer:
Name of Supervisor:
No. Supervised (if any): Hours per Week:
Reason for Leaving:
Telephone Number of Employer:
From: To:
Title of Your Position:
Mo. Yr. Mo. Yr.
Duties:
Name and Address of Employer:
Name of Supervisor:
No. Supervised (if any): Hours per Week:
Reason for Leaving:
Telephone Number of Employer:
6. CERTIFICATE OF APPLICANT - PLEASE READ CAREFULLY
If employed, will you take a loyalty oath of Public Officers and Employees?
This is to inform you that as part of our procedure for processing your application an investigative background report, including a DMV check, may
be made through a personal interview with you and/or any third parties who may have information concerning you/or a record search.
All offers of employment are conditioned upon the successful passing of a physical, including a drug screen, and/or psychological examination. The
use of this application form does not indicate that there are any positions open and does not in any way obligate the City to process your application
and/or hire you.
CERTIFICATION: I certify that the answers given by me to the foregoing questions and statements are true and correct without consequent
omissions of any kind whatsoever. I agree that the City shall not be liable in any respect if my employment is terminated because of the falsity of
statements, answers or omissions made by me in this application. I authorize the companies, schools or persons named above to give any information
regarding my employment that they may have regarding me whether or not it is in their record. I hereby release said companies, schools or persons
from all liability for any damage for issuing this information.
Signed: Date:
List all periods of employment and unemployment for the last ten years, starting with the most recent and working back. Start with present employment,
including current employment with the City. Indicate any discharge or forced resignation. List periods of U.S. Military Service and previous employment with
the City of Huntington Park regardless of when they occurred. List separately different positions with the same employer. Give complete information. A resume
does not substitute for this section. If you need additional space use the back of the application or attach additional sheets using this format.