Fillable Kern Council Of Governments Street, Suite 300 1401

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Kern Council Of Governments Street, Suite 300 1401

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EMPLOYMENT APPLICATION
Kern Council of Governments
1401 19
th
Street, Suite 300
Bakersfield, CA 93301
(661) 635-2900
(An Equal Opportunity Employer)
D
ated Filed:______________________ Position Desired:__________________________________________
PERSONAL DATA:
Last Name_____________________________________First Name_________________________________M.I._________
Address:________________________________________________________________________________________________
City State Zip
Telephone Number:_____________________________ ____________________________ ________________________
Home Work Other
Do you have the legal right to work in the U.S.? Yes No
Are you able to perform the essential functions of the job you are applying for with or without reasonable
accommodation? Yes
No
Are you a veteran of the U. S. armed forces? Yes
No
EDUCATION DATA:
Completed High School: Yes No GED
L
ast High School Attended:______________________________________________________________________________
Address
C
olleges and Business or Trade Schools Attended:
1.______________________________________________________________________________________________________
Name of institution Address
______________________________________________________________________________________________________
Major subject Units earned Degree earned
2.______________________________________________________________________________________________________
Name of institution Address
_______________________________________________________________________________________________________
Major subject Units earned Degree earned
Continuing Professional Education:____________________________________________________________________
_______________________________________________________________________________________________________
Professional Affiliations:_______________________________________________________________________________
____
___________________________________________________________________________________________________
EMPLOYMENT HISTORY:
List employment history from most to least recent:
1. Employer:________________________________________________________From:______________To:_____________
Address:______________________________________________________________Telephone:_______________________
Job title:__________________________________________Duties:______________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Reason for leaving:______________________________________________________________________________________
2. Employer:________________________________________________________ From:_____________ To:_____________
Address:____________________________________________________________ Telephone:_________________________
Job title:_______________________________________Duties:__________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Reason for leaving:______________________________________________________________________________________
3. Employer:________________________________________________________From:______________To:____________
Address:_____________________________________________________________Telephone:________________________
Job title:_________________________________________Duties:________________________________________________
_________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Reason for leaving:______________________________________________________________________________________
REFERENCES:
1.________________________________________________________________________________________________________
Name Address Telephone
2._______________________________________________________________________________________________________
Name Address Telephone
3._____________________________________________________________________________________________________
Name Address Telephone
I hereby certify that all information contained in this application is true, correct and complete and that false statements or
information may subject me to disqualification or termination. Kern COG is hereby granted authorization to use this
information as deemed appropriate in the selection process.
Signature of applicant:_______________________________________________________Date:_________________________
ATTACH RESUME AND USE ADDITIONAL SHEETS IF NECESSARY
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Kern Council Of Governments Street, Suite 300 1401

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Completed 6 August 2020

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