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Pasadena City College
Applicant Submittal Certification
for Superintendent/President
First Name Last Name
Mailing Address
E-mail Address Home Phone
Cell Phone
Have you been or are you now
employed by Pasadena City College? If previously employed, when?
Yes No __________________________________________
Do you have any relatives
employed at Pasadena City College? If yes, give name and relationship.
Yes No __________________________________________
Are you a U.S. citizen or can you provide evidence of your legal right to work in the
United States?
Yes No
I certify that the information contained in this application is correct to the best of my knowledge and understand that
deliberate falsication or any misstatements and omissions of material facts may be cause for refusal of employment; or,
if employed, cause for dismissal.
I authorize previous employers to provide any and all pertinent information they may have, personal or otherwise, and
release all parties from all liability for any damage that may result from furnishing same to Pasadena City College.
If employed, I understand that I will be required to submit verication of my identity and authorization to work in the United
States, and that additional information about me will be required for statistical purposes.
By checking yes below, I acknowledge that I have carefully read the above. I understand and agree to all of the
statements.
Yes No
