Shasta Mosquito & Vector Control District Employment Application 2025

Shasta MVCD is an equal opportunity employer. This application will not be used to limit or exclude any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify an organization representative.

INSTRUCTIONS. Attach additional information, if desired, to continue your employment history or to describe in greater detail any aspects of your experience or activities that are particularly appropriate for the position for which you are applying. Any false or misleading statements knowingly made by you in this application will result in the forfeiture of all rights to employment in the service of the Shasta Mosquito & Vector Control District. If offered

employment, a physical examination & a background check will be required.

Position Applying for

Name

Email

example@example.com

City

State

Zip

Cell Phone

Yes:No:

Yes:

List areas of special interest or abilities

Have you graduated from high school, or do you have a GED? Yes:No:

Education:

Rows	University / College / Trade Vocational School	Courses of Study / Major / Minor	Did You Graduate?	Units, Hours, Degrees

List special qualifications, apprenticeships, or any other special training you have received. Include type, where acquired, dates, whether completed, and any other applicable information:

List any special skills or experience e.g., operating machinery, etc

Probable date available to start employment

Date

Describe any aspects of your experience or activities that are particularly appropriate for the position for which you are applying:

Give names and email addresses of people other than relatives or former employers:

Rows	Name	E-Mail	Telephone

List your present job in reverse order, including self-employment. Include any promotions as a separate job.

Job Title

Employer

Dates Employed

Date

Supervisor’s Name & Title

Reason For Leaving

Phone

Duties/Responsibilities

Job Title

Employer

Dates Employed

Date

Supervisor’s Name & Title

Reason For Leaving

Phone

Duties/Responsibilities

Job Title

Employer

Dates Employed

Date

Supervisor’s Name & Title

Reason For Leaving

Phone

Duties/Responsibilities

Yes:No:

Which website did you see this position posted?*

I certify that all statements above are correct and complete to the best of my knowledge. I understand that false statements shall be sufficient cause for denial of employment or subsequent dismissal.

Signature*

Date*

Date

Please read carefully, initial each paragraph and sign below.

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material facts on this application or any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed.*

I hereby authorize the District to thoroughly investigate my background, references, work record, education, and other matters related to my suitability for employment upon a contingent offer of employment. Any offer of employment will be conditioned upon (i) successfully clearing a post-offer criminal background check, (ii) successfully passing of a post-offer, pre-employment drug test, (iii) successfully passing a post-offer, pre-employment medical exam, and (iv) provision of satisfactory documentation verifying identity and authority to work in the United States in compliance with USCIS Form I-9.*

I understand that any job offer made to an applicant may be contingent on the applicant’s passing a job-related physical examination and taking and passing a drug screen test.*

I understand that a valid California driver’s license will be required and must be maintained throughout employment in this class. Applicant must be insurable with the District’s insurance carrier. (Any job offer made to an applicant may be contingent on the applicant’s Motor Vehicle Report.)*

I understand that nothing in the application, or conveyed during my interview which may be granted or during my employment, if hired, is intended to create an employment contract between the District and me. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the District, and that no promises or representations contrary to the foregoing are binding on the District unless made in writing and signed by me and the District’s designated representation.*

Applicant’s Name

Applicant’s Signature*

Date*

Date

ALL COMPLETED APPLICATIONS CAN BE EMAILED TO APPLY@SHASTAMOSQUITO.ORG