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HomeMy WebLinkAboutjob_app.pdfInstructions for completing a City of Santa Ana Job Application STEPS: 1.The City’s job application can be completed by tabbing from one field to another and inputting the appropriate information requested. 2.You may either click or hit the space bar for those boxes requiring a check mark. 3.After the application has been completed, please print. 4.Please sign your application in ink. 5.Submit the signed application and any other required documentation (i.e. supplemental application, certificates) to: City of Santa Ana Personnel Services, M-24 20 Civic Center Plaza, 5 th floor PO Box 1988 Santa Ana, CA 92702-1988 6.Applications must be received by the closing date of the job bulletin in the Personnel Services Agency. Postmarks, faxed applications or résumés will not be accepted in lieu of original City application. Note: A separate application form must be submitted for EACH recruitment. APPLICATION FOR EMPLOYMENT CITY OF SANTA ANA PERSONNEL SERVICES DEPARTMENT 20 CIVIC CENTER PLAZA, M -24 P.O. BOX 1988 SANTA ANA, CA 92702 (714) 647-5340 The City of Santa Ana is an equal opportunity employer. We encourage all persons to file applications w ith us and we do not discriminate on the basis of race, color, religion, age, sex, national origin, veteran status, mental or physical disability. All job offers are contingent upon the successful completion of a background process which may include a police records check and a medical examination which includes drug screening. PLEASE TYPE OR PRINT LEGIBLY. THIS APPLICATION IS PART OF THE EXAMINATION PROCESS. RESUME MAY BE ATTACHED, BUT IS NO SUBSTITUTE FOR COMPLETING THIS APPLICATION PRINT EXACT TITLE OF THE POSITION YOU ARE APPLYING FOR: ARE YOU UNDER 18 YEARS OF AGE ? YES NO ENTER JOB BULLETIN NUMBER (See lower left corner of Job announcement flyer) APPLICANT, CHECK ONLY IF APPLYING FOR A PUBLIC SAFETY POSITION. ARE YOU OVER 60 YEAR S OF AGE? YES NO TELEPHONE/CONTACT INFORMATION: HOME: ( ) BUSINESS: ( ) E-MAIL: PRINT YOUR FULL NAME: (Last) (First) (Middle) ADDRESS: (Number) (Street) (Apt. No.) (City) (State) (Zip Code) DRIVER'S LlCENSE # STATE CLASS EXPIRATION DATE SOCIAL SECURITY NUMBER WHAT LANGUAGES OTHER THAN ENGLISH DO YOU SPEAK AND UNDERSTAND FLUENTLY? HAVE YOU THE LEGAL RIGHT TO WORK PERMANENTLY1NTHEUNITEDSTATES? YES NO HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR OR FELONY BY A COURT OF LAW OR A MILITARY TRIBUNAL (do not include or disclose convictions that are over two years old which involved violations of Health and Safety Code sections 11357, 11360, 11364, 11365 or 11550, as those statutes related to marijuana prior to January 1, 1976, or a statutory predecessor to those statutes)? YES NO IF YES, GIVE DETAILS BELOW. EMPLOYABILITY WILL DEPEND UPON THE NATURE OF THE OFFENSE, THE JOB IN QUESTION, AND THE CONDUCT OF THE APPLICANT SINCE THE OFFENSE WAS COMMITTED. ARE YOU RELATED TO ANYONE WORKING FOR THE CITY OF SANTA ANA? YES NO IF YES, IN WHAT DEPARTMENT IS YOUR RELATIVE EMPLOYED: NAME OF RELATIVE: RELATIONSHIP: DATE CITY AND STATE OFFENSE PENALTY OR DISPOSITION EDUCATION CIRCLE HIGHEST GRADE COMPLETED NAME AND LOCATION OF SCHOOL 1 2 3 4 5 6 7 8 9 10 11 12 DID YOU GRADUATE FROM HIGH SCHOOL? YES NO DO YOU HAVE A GED CERTIFICATE? YES NO COLLEGE OR UNIVERSITY ATTENDED ATTENDANCE DATES MAJOR UNITS DEGREE RECEIVED OTHER JOB RELATED TRAINING PROFESSIONAL LICENSES OR CERTIFICATES PROFESSIONAL MEMBERSHIPS REMARKS: U.S. ARMED FORCES YES (IF YES. COMPLETE SECTION BELOW) NO BRANCH OF SERVICE YEARS OF ACTIVE DUTY DATE OF SEPARATION FROM ACTIVE DUTY RANK IF YOU WISH TO CLAIM VETERAN'S CREDIT YOU MUST ATTACH A COPY OF FORM DD214 TO YOUR APPLICATION EXPERIENCE: LIST YOUR PRESENT OR MOST RECENT JOB FIRST. CAREFULLY ACCOUNT FOR ALL RECENT EMPLOYMENT (AT LEAST THE LAST TEN YEARS). BY GIVING COMPLETE INFORMATION, YOU WILL IMPROVE YOUR CHANCES FOR EMPLOYMENT. IF YOU NEED MORE SPACE, PLEASE ATTACH ADDITIONAL SHEETS. MAY WE CONTACT YOUR PRESENT EMPLOYER? YES NO IF 'NO' EXPLAIN: FROM: MONTH / YEAR TO: MONTH / YEAR TITLE OF YOUR POSITION NAME AND AD DRESS OF EMPLOYER NAME OF SUPERVISOR PHONE NO. DUTIES OF YOUR POSITION REASON FOR LEAVING NO. SUPERVISED (IF ANY) PER: WEEK SALARY $ HOUR MONTH HOURS PER WEEK FROM: MONTH / YEAR TO: MONTH / YEAR TITLE OF YOUR POSITION NAME AND ADDRESS OF EMPLOYER NAME OF SUPERVISOR PHONE NO. DUTIES OF YOUR POSITION REASON FOR LEAVING NO. SUPERVISED (IF ANY) PER: WEEK SALARY $ HOUR MONTH HOURS PER WEEK FROM: MONTH / YEAR TO: MONTH / YEAR TITLE OF YOUR POSITION NAME AND ADDRESS OF EMPLOYER NAME OF SUPERVISOR PHONE NO. DUTIES OF YOUR POSITION REASON FOR LEAVING NO. SUPERVISED (IF ANY) PER: WEEK SALARY $ HOUR MONTH HOURS PER WEEK FROM: MONTH / YEAR TO: MONTH / YEAR TITLE OF YOUR POSITION NAME AND ADDRESS OF EMPLOYER NAME OF SUPERVISOR PHONE NO. DUTIES OF YOUR POSITION REASON FOR LEAVING NO. SUPERVISED (IF ANY) PER: WEEK SALARY $ HOUR MONTH HOURS PER WEEK FROM: MONTH / YEAR TO: MONTH / YEAR TITLE OF YOUR POSITION NAME AND AD DRESS OF EMPLOYER NAME OF SUPERVISOR PHONE NO. DUTIES OF YOUR POSITION REASON FOR LEAVING NO. SUPERVISED (IF ANY) PER: WEEK SALARY $ HOUR MONTH HOURS PER WEEK USE THIS SPACE FOR ANY ADDITIONAL INFORMATION YOU WISH TO PROVIDE CONCERNING YOUR QUALIFICATIONS FOR THIS POSITION. I HEREBY CERTIFY THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE AND COMPLETE TOTHE BEST OF MY KNOWLEDGE AND BELIEF I UNDERSTAND THAT FALSE STATEMENTS ARE CAUSE FOR REJECTION OF APPLICATION, REMOVAL OF NAME FROM ELIGIBLE LIST OR DISMISSAL FROM POSITION (SANTA ANA MUNICIPAL CODE SECTION 9.5(J) SIGNATURE OF APPLICANT DATE PRINT YOUR NAME In order to comply with Federal Regulations in the area of Equal Employment Opportunity, the City of Santa Ana requests that applicants provide the following information. This is voluntary. The information will be treated confidentially and will not r esult in adverse treatment of any individual. This information may be provided to State and Federal regulatory agencies. POSITION APPLYING FOR: JOB BULLETIN NO: DATE: LAST NAME: FIRST NAME: MIDDLE INITIAL: ADDRESS: CITY/STATE/ZIP CO DE: SOCIAL SECURITY NO: SEX: AGE: ETHNIC BACKGROUND (see below for definitions): White Asian or Pacific Islander Black American Indian Hispanic Other EDUCATION (check the highest grade completed): GED: YES NO 1 2 3 4 5 6 7 8 9 10 11 12 COLLEGE EDUCATION (check appropriate number): 1 2 3 4 5 6 7 8 AA BA/BS MA/MS Ph.D. Please take a few moments to answer the following question. Your response will help us assess how effective our recruitment efforts were for this position. How did you hear about this employment opportunity? Friend/Relative TV (list station) City Employee Radio (list station) Community Center L.A. Times Newspaper Jobs Available Orange Co Register New spaper City Website Other Newspaper (list name) Other Website (list names) Other Source(s) Ethnic/racial definitions are those prescribed by the Equal Employment Opportunity Commission (see U.S.C., Title 29, Chapter XIV, Subpart 1, Section 1602.30). 1. The category “White” (not of Hispanic origin): all persons having origins in any of the original people of Europe, North Africa or the Middle East. 2. The category “Black” (not of Hispanic origin): all persons having origins in any of the Black racial groups of Africa. 3. The category “Hispanic”: all persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture of origin, regardless of race. 4. The category “Asian or Pacific Islanders”: all persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands, and Samoa. 5. The category “American Indian or Alaskan Native”: all persons having origins in any of the original peoples of North America, and who maintain cultural identification through affiliation or community recognition.