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CCSFApplication

This document is an application for employment with the City and County of San Francisco. It requests basic personal information from the applicant such as name, address, education history, employment history, languages spoken, and convictions. It also provides checkboxes for the applicant to indicate their qualifications, references, and if they authorize their current employer to be contacted. The applicant must certify that all information provided is true and accurate.

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Matt T Dea
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© Attribution Non-Commercial (BY-NC)
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Download as DOC, PDF, TXT or read online on Scribd
44 views

CCSFApplication

This document is an application for employment with the City and County of San Francisco. It requests basic personal information from the applicant such as name, address, education history, employment history, languages spoken, and convictions. It also provides checkboxes for the applicant to indicate their qualifications, references, and if they authorize their current employer to be contacted. The applicant must certify that all information provided is true and accurate.

Uploaded by

Matt T Dea
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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FOR OFFICE USE ONLY Analyst____________Date________ Qualified Hold - must submit: _____________________ by:__________________ Rejected for: experience education

ation late filing verification other: _________________________

Submit Completed Application to the Address Indicated on the Job Announcement

ANSWER ALL QUESTIONS - TYPE OR PRINT IN INK READ THE EXAMINATION ANNOUNCEMENT BEFORE COMPLETING THIS FORM Position I am applying for: Class# Title Last Name Street Address City E-Mail Address: Other surname(s) I have used: Social Security Number You may may not contact my present employer. I am currently employed by the City and County of San Francisco: Yes If yes, Class Number and Title: Department: Employment Status: No Start Work Date in this class: Temporary Civil Service (from a list) Exempt from Civil Service Starting Date: State First Name Apt. No. Zip Code Specialty (if required by announcement) Middle Initial Home Telephone Number ( ) -

Cellular Number
( ) -

Unit or Division: Permanent Civil Service (from a list) Provisional (not from a list) write the following language(s) besides English:

Permanent Class Number if other than a class listed above: I can speak read

I have a Driver License No Yes--If yes, Number Class: State: Expiration: If required for this job, list license, certificate and/or registration (for example, Registered Nurse License, Engineers Certificate, etc.): Title Issued By Number Date Issued Date Expires I have been convicted by a court of an offense: No Yes (you must explain)
On a separate piece of paper, list your name, the job code(s) and title(s) that you are applying for, and the following details for each offense: the violation, the court (including military), the place and date of conviction, the penalty (fine, sentence, date(s) of probation), and the name under which convicted if other than that listed above. You may omit any traffic offense for which the fine was less than $200, and any record that has been sealed or expunged by the court. Conviction is not necessarily a bar to employment. Each case is given individual consideration based on the job-relatedness of the offense.

CERTIFICATION OF APPLICANT (read carefully): I hereby certify that all statements made in this application are true and complete
to the best of my knowledge. I understand that any false, incomplete, or incorrect statement, regardless of when it is discovered, may result in my disqualification or dismissal from employment with the City and County of San Francisco. I hereby authorize all my employers and schools (unless otherwise noted) to release any and all information concerning me, including information of a confidential or privileged nature. I hereby release any and all employers from any liability or damage which may result from furnishing the information requested.

Date

Signature of Applicant

LAST NAME

FIRST NAME

M.I.

Check appropriate box if you possess one of the following High School Diploma G.E.D. Certificate
COLLEGE: BUSINESS/TRADE SCHOOLS; SPECIAL TRAINING: NAME AND LOCATION

California High School Proficiency Certificate


COURSE OF STUDY/MAJOR UNITS COMPLETED DATE DEGREE/ CERTIFICATE AWARDED TYPE DEGREE/ CERTIFICATE

EMPLOYMENT HISTORY - YOU MUST COMPLETE THIS SECTION. Do not attach a resume as a substitute. Begin with your most recent experience,

starting with your current job. Be sure to include all experience, regardless of dates, which demonstrates that you meet the minimum requirements as shown on the announcement for the position. Attach additional sheets if you need more space to describe duties or list former employers. Describe your duties as completely as possible. Incomplete information may cause a delay in processing your application. If you supervise(d) employees, include the number of employees you supervise(d). If you held more than one position with the same employer, list each separately.
MO/YR HOURS PER WEEK SALARY REASON FOR LEAVING MO/YR EMPLOYERS NAME AND ADDRESS TITLE OF YOUR POSITION DUTIES PERFORMED

MO/YR TO HOURS PER WEEK SALARY

MO/YR

EMPLOYERS NAME AND ADDRESS

TITLE OF YOUR POSITION DUTIES PERFORMED

REASON FOR LEAVING

MO/YR TO HOURS PER WEEK SALARY

MO/YR

EMPLOYERS NAME AND ADDRESS

TITLE OF YOUR POSITION DUTIES PERFORMED

REASON FOR LEAVING

Class # applying for: Name:

Title:

Date:

(Last) (First) (M.I.) The Department of Human Resources is legally allowed to gather this information. This information which is voluntary will not be used for employment decisions. Code: Circle the number that applies to you: 1. White (not of Hispanic origin) - Persons having origins in any of the originals peoples of Europe, North Africa, or the Middle East. 2. Black (not of Hispanic origin) - Persons having origins in any of the Black racial groups of Africa. 3. Hispanic - Persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish Culture or origin, regardless of race. 4. Asian or Pacific Islander (except Filipino) - 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, and Samoa. 5. Filipino - Persons having origins in any of the original peoples of the Philippine Islands. 6. American Indian or Alaskan Native - Persons having origins in any of the original peoples of North America who maintain cultural identification through tribal affiliation or community recognition. SEX: Check One: Male Female

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