City of Guadalupe Employment Application

City of Guadalupe
Physical: 918 Obispo Street, Guadalupe, CA 93434
Mailing: P.O. Box 908, Guadalupe, CA 93434
Phone: (805) 356-3893 | Fax: (805) 343-5512
EMPLOYMENT APPLICATION
The City of Guadalupe is an equal opportunity employer. No question on this application is asked for the purpose of illegally limiting or excluding any applicant’s consideration for employment because of race, color, religion, sex, age, national original, marital status, ancestry, or physical handicap.
Position Applied For*
Date of Application

MonthDayYear
Date
Referral Source:

AdvertisementEmployeeRelativeWalk-InOther
If Employee/Relative, list name:
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Email*
example@example.com
May we contact you at work

YesNo
If yes, work number:
Please enter a valid phone number.
Best Time to Call

Hour Minutes

AM/PM Option
If you are under 18 and upon employment, can you furnish a work permit?

YesNo
Have you ever used a different name?

YesNo
If yes, what name(s)
Separate the names with a comma
Have you submitted an application here before?*

YesNo
If yes, give the date(s) and position(s)
Separate the items with a comma
Have you ever been employed here before?

YesNo
If yes, give the date(s) and position(s)
Separate the items with a comma
Upon hire, can you provide verification of your legal right to work in the United States?*

YesNo
What languages, other than English, do you speak?
What languages, other than English, do you read?
What languages, other than English, do you write?
Are you able to perform the essential functions of the position for which you are applying, either with or without reasonable accommodations?

YesNo
Type of employment you will accept

Full-TimePart-TimeTemporarySeasonal
Do you possess a valid Driver’s License?

YesNo
If yes, State?
License Number?
License Class?
EMPLOYMENT HISTORY
Dates Employed From

MonthDayYear
Date
Dates Employed To

MonthDayYear
Date
Name of Employer

First NameLast Name
Job Title
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name and Title of Supervisor
Employer Phone
Please enter a valid phone number.
May We Contact?

YesNo
Reason for Leaving
Description of Duties
Dates Employed From

MonthDayYear
Date
Dates Employed To

MonthDayYear
Date
Name of Employer

First NameLast Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name and Title of Supervisor
Employer Phone
Please enter a valid phone number.
May We Contact?

YesNo
Reason for Leaving
Description of Duties
Dates Employed From

MonthDayYear
Date
Dates Employed To

MonthDayYear
Date
Name of Employer

First NameLast Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name and Title of Supervisor
Employer Phone
Please enter a valid phone number.
May We Contact?

YesNo
Reason for Leaving
Description of Duties
Dates Employed From

MonthDayYear
Date
Dates Employed To

MonthDayYear
Date
Name of Employer

First NameLast Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name and Title of Supervisor
Employer Phone
Please enter a valid phone number.
May We Contact?

YesNo
Reason for Leaving
Description of Duties
EDUCATION
Did you graduate High School or receive a GED?*

YesNo
Name/Location of school attended (Not High School)
Course/Major
Degree or Certificate
AA/AS, BA/BS, Masters, Certificate of Completion, etc.
Completed?

YesNo
Name/Location of school attended (Not High School)
Course/Major
Degree or Certificate
AA/AS, BA/BS, Masters, Certificate of Completion, etc.
Completed?

YesNo
Name/Location of school attended (Not High School)
Course/Major
Degree or Certificate
AA/AS, BA/BS, Masters, Certificate of Completion, etc.
Completed?

YesNo
List computer skills - specify software expertise, spreadsheets, etc.
List any professional licenses/certificates, specialized skills, etc.
List any professional trade, business or civic associations and any offices held.
You may omit those which indicate your race, creed, color, national origin, ancestry, sex, age, sexual orientation, disability, or any other similarly protected status.
Additional information supporting your qualifications for this position
REFERENCES
List the names and telephone numbers of three business/work references that are NOT related to you. If not applicable, list three school or personal references that are NOT related to you.
Name
Phone
Years Known
Name
Phone
Years Known
Name
Phone
Years Known
Have you ever been fired or asked to resign in order to avoid being fired from a job?*

YesNo
If "yes", please complete the following (List all cases except layoffs for lack of work. Attach additional sheet if necessary). (NOTE: Promotional applicants must list all probationary terminations while employed by the City but are not required to list terminations occurring prior to original City appointment if employed by the City for at least one year.):
Employer's Name
Employer's Address
Date and reason for discharge
RESEARCH AND SPECIAL DATA. The City of Guadalupe is an Equal Employment Opportunity Employer. We request voluntary identification of your gender and ethnic/racial group and/or disability so that we can monitor the effectiveness of our Equal Employment Opportunity program. Completing the following four (4) sections will not affect your employment.
With which gender do you most identify?*

MaleFemaleNon-Binary
Ethnic Group/Race*

African AmericanHispanicAsianCaucasianNative AmericanNative Hawaiian or Pacific IslanderTwo or More Races
Reasonable Accommodations

City examinations may include written tests, interviews, physical abilities tests or other processes. Reasonable accommodation will be provided to applicants who need assistance to participate in the selection process. Please review the Selection Process of the Job Bulletin for the types of tests included in this examination.
Do you need a reasonable accommodation to participate in the selection process?*

YesNo
If Yes, please describe the desired accommodation*
Have you ever been granted an accommodation for a previous City examination?

YesNo
You will be contacted by telephone or by mail regarding your request for reasonable accommodation. If you have not previously done so, you will be required to provide written verification from an appropriate professional confirming your disability and appropriate accommodation. Verification forms may be obtained from the Human Resources Department or by calling (805) 356-3893.
Recruitment Research: For open candidates, please indicate where you learned about this job.

Notification CardFriend or RelativeCity Bulletin BoardCity EmployeeNewspaper AdCareer Day/Job Fair24-Hour JoblineCity Council Video FeedInternetOther
If Internet, please provide website
Pursuant to AB218, the City of Guadalupe will no longer request conviction information or proof of safe driving record at the time of application submission for paid employment. Only candidates who pass the application screening process will be required to provide conviction information to the Human Resources Department. Conviction information will still be required with initial application for any position where a background check is required by law or exempt from AB218.

Upon request for conviction information by the Human Resources Department, failure to disclose misdemeanor or felony convictions will result in termination or denial of employment. Newly hired employees are subject to being fingerprinted, to verify conviction history, prior to start of work.

Pursuant to California Public Resources Code Section 5164, the City is prohibited from hiring an employee or volunteer to perform services at a park, playground, recreation center or beach, in a position having supervisory or disciplinary authority over any minor, when that person has been convicted of specified offenses. You may obtain a CODE SECTION 5164 SCREENING FORM, which includes applicable offenses, from the Human Resources Department.
NOTICE TO APPLICANTS
VETERANS' PREFERENCE SYSTEM IN SELECTION PROCESS

The City of Guadalupe has implemented a Veterans' Preference System. If you are a veteran who served active duty in the U.S. Armed Forces for a period of at least 24 continuous months and received an honorable discharge, you are eligible. Reserve and inactive service time does not count toward the required 24 months of continuous active duty.

To be considered for veterans' preference status, a certified copy of your most recent DD-214 form, or an acceptable equivalent, must be submitted with your completed and signed City application, on or before the final filing date for the recruitment. PLEASE NOTE: VETERANS' PREFERENCE STATUS MUST BE ESTABLISHED FOR EACH CITY POSITION FOR WHICH YOU APPLY.

If you meet the minimum qualifications established for a City position, receive a passing score in each testing phase of the recruitment process, and qualify for veterans' preference status, the City will apply an additional 10 points to your final examination score. Your final score is used to determine your placement on a certified eligibility list.

Answer the next two questions ONLY if you are applying for a peace officer position with the Guadalupe Policy Department.

If not, please DISREGARD and move on to the Applicant Statement section.
Have you ever plead guilty or "no contest" to, or been convicted of, a misdemeanor or felony?

YesNo
If YES, please give the date(s) and details.
Note: Answering "yes" to this question is not an automatic bar to employment. Each case is considered on its own merits. Do not include minor traffic infractions, convictions that have been sealed, or convictions which have been expunged.
APPLICANT STATEMENT
I certify that all information, answers and statements I have provided in order to apply for and secure work with the City of Guadalupe are true, complete, and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to 1) cancel further consideration of this application; or 2) immediately discharge me from the City of Guadalupe, whenever it is discovered.

I expressly authorize, without reservation, the City of Guadalupe, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions, and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the City of Guadalupe, its representatives, employees or agents for seeking, gathering, and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me.

I understand that the City of Guadalupe does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any application from consideration for employment on the basis prohibited by applicable local, state and federal laws.

I understand that this application does not constitute an agreement or contract for employment for any specified period or definite duration. I further understand that no supervisor or representative of the City of Guadalupe is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the City Administrator of the City of Guadalupe.

I certify that I have read and meet the requirements listed in the job description / announcement posted for which this application is being submitted. In connection with this application and if I am hired, I understand that I will be required to provide proof of identity and legal authority to work in the United States and that Federal Immigration laws require me to complete an I-9 form in this regard.

I understand that any misrepresentation or deliberate omission in my application may be justification for termination or refusal of employment. If required, I agree to undergo a physical examination if a job offer is made and understand that employment is contingent upon meeting the City's physical requirements. I also authorize employers, schools or persons named in this application to give any information regarding my qualifications an character. I hereby release said employers, schools, persons and the City from any liability for damages for receiving or releasing information. I, if requested, agree to be fingerprinted. I further agree to furnish proof of citizenship or right to work.
DO NOT SIGN AND SUBMIT THIS FORM UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
RELEASE FOR VERIFICATION OF EMPLOYMENT AND CHARACTER REFERENCES

I refer you to individuals as listed on the employment application or added thereto for information as to my character, ability, and work record.

I hereby release all former employers, their representatives, and the individuals listed from any and all liabilities which may or may not result from information supplied to them by the City of Guadalupe.

I am willing to take a physical, and other examinations, when required.

I understand that misrepresentations or omission of facts called for on the employment application is cause for dismissal

A copy of the document will serve as the Original
I agree to the Release for Verification of Employment and Character References*

I AgreeI DO NOT Agree
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Type Your Full Name*
Signature*

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Date
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City of Guadalupe

EMPLOYMENT APPLICATION

EMPLOYMENT HISTORY

EDUCATION

REFERENCES

APPLICANT STATEMENT

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.