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LAFCO
of Monterey County
Employment Application
An Equal Opportunity Employer
Please return this application completed, signed, and dated to:
LAFCO of Monterey County
132 W. Gabilan St.
Salinas, CA 93901 or
PO Box 1369
Salinas, CA 93902
1. Social Security Number:
2. Exam Number:
3. Position Applied for: Senior Analyst
4. Last Name:
First:
Middle Initial:
5. Mailing Address:
City:
State:
Zip:
6. Daytime Telephone:
Home Telephone:
Email address:
7.Driver's License Number:
Class:
Expiration:
State:
8. Are you able to produce documents that verify your right to work in the United States?
Persons under age 18 must be able to produce a valid work permit upon employment.
Yes
No
9. Are you currently a LAFCO employee?
Yes
No
10. Have you ever been employed by LAFCO of Monterey County? If yes, indicate:
Yes
No
Dates: _______________________________Position:__________________________________________
Name(s) at time of employment:_________________________________________________
11. Do you have any relatives employed by LAFCO of Monterey County?
Yes
No
There may be limitations on the employment of Father, Mother, Brother, Sister, Wife, Husband and Child. Each case is considered
separately for potential conflict of interest. If yes, indicate:
Name: _______________________________Department: __________________________Relationship:__________________________
Name: _______________________________Department: __________________________Relationship:__________________________
12. What type of work will you accept? (Check all that apply)
Type of Hire:
Hours Worked:
Permanent
Full Time
Temporary
Part Time
Seasonal
On Call
13. How soon are you available for
employment?
____________________________________
14. Have you ever been convicted of a crime? (If yes, indicate. This information will be reviewed for job
relatedness. Use an additional sheet of paper if necessary.)
Yes
No
Date:_________________________________Charge ____________________________________________________________________
Location: _____________________________ Action Taken: ______________________________________________________________
15. Second Language Skills: If you have no second language, skip this question and go to question 18. Please indicate your level of skill
in the following languages (other than English) by selecting the appropriate letter code in front of the language. CHOOSE ONLY ONE
LETTER CODE PER LANGUAGE.
Letter Codes: 1 = I can carry on a conversation freely but cannot read/write.
2. = I can carry on a conversation and can read/write.
Choose appropriate box below:
1 2 Spanish
1 2 Ilocano
1 2 Tagalog
1 2 Korean
1 2 Vietnamese
1 2 Other (Specify)____________________
Applicant Name: ______________________________________________________ Exam Number: ________________________________
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16. EDUCATION AND TRAINING SUMMARY
Provide information for education as it relates to the position for which you are applying.
Colleges, Vocational or Technical Schools,
Training Center
Major Subject
Units Completed
Type Degree/Certificate
Licenses and Certificates (State, Professional, Nursing, Trade, etc. which are required for this position).
17. EMPLOYMENT HISTORY
Begin with your present or most recent job. List all jobs separately including on-the-job training, volunteer work and military experience.
Please be sure you describe completely in the section below the duties you performed which demonstrate that you have the knowledge
and skills to perform the duties of the position for which you are applying. You may use additional sheets to complete your work history.
A resume may be attached but is not a substitute for the application or for completing this section. THIS SECTION MUST BE
COMPLETED. If a response to a supplemental questionnaire is required, it must accompany this application. (Incomplete applications
may be returned.)
Date and Salary Information
Employer Information
Occupation and Description of Duties
From:
Employer:
Job Title:
To:
Address:
(Mo/Day/Year) Telephone:
Monthly Salary: $
Supervisor's Name:
Hours per week:
Supervisor's Title:
Reason for Leaving:
Your Duties:
From:
Employer:
Job Title:
To:
Address:
(Mo/Day/Year) Telephone:
Monthly Salary: $
Supervisor's Name:
Hours per week:
Supervisor's Title:
Reason for Leaving
Your Duties:
From:
Employer:
Job Title:
To:
Address:
(Mo/Day/Year) Telephone:
Monthly Salary: $
Supervisor's Name:
Hours per week:
Supervisor's Title:
Reason for Leaving
Your Duties:
18. I hereby certify that all information or omission of any material fact on this application is true to the best of my knowledge and
understand that falsification of information on this application may lead to the removal of my name from the eligibility list or termination
from employment.
Signature of Applicant: _____________________________________________________ Date: ______________________________________
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EQUAL EMPLOYMENT OPPORTUNITY SELF-IDENTIFICATION FORM
This form will be detached from your employment application and will be treated as confidential. In order to achieve and maintain
equal employment opportunity, LAFCO of Monterey County requests that all persons complete this portion of the application. If you
require test accommodation due to a disability, please call (831) 754-5838. Please make the request at the time of application.
1. Ethnic Category : (Choose only one)
WHITE (not of Hispanic Origin)
All persons having origins in any of the original peoples of Europe, North Africa or the Middle East
BLACK (not of Hispanic Origin)
All persons having origins in any of the Black racial groups of Africa
HISPANIC
All persons of Cuban, Mexican, Puerto Rican, Central or South American or other Spanish culture or origin, regardless of race
ASIAN or PACIFIC ISLANDER
All persons having origins in any of the original peoples of the Far East, Southeast Asia, Indian Subcontinent, or Pacific Islands
(does not include Filipinos)
FILIPINO
All persons having origins in the peoples of the Philippine Islands
AMERICAN INDIAN or ALASKA NATIVE
All persons having origins in any of the original peoples of North America and who maintain cultural identification through
Tribal affiliation or community recognition
2. Gender
Male
Female
3. Are you 40 years of age or older?
Yes
No
4. Do you require test accommodation?
Yes
No
5. Job Source Information
I learned about this job opening through (check the appropriate boxes)
Friend/Relative
LAFCO Employee
LAFCO Employment Announcement
LAFCO Office
Interest Card
Organization/Group (please specify) ______________________________________________
Advertisement (please specify which paper/magazine/radio) __________________________
Website - LAFCO of Monterey County
Website - Other (please specify) _________________________________________________
Other (please specify) __________________________________________________________
download Employment Application An Equal Opportunity Employer
