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Alpine County Application for Employment 40 Diamond Valley Rd. Markleeville, CA 96120 [PHONE REDACTED] www.alpinecountyca.gov [EMAIL REDACTED] Alpine County is an equal opportunity employer. At Alpine County, we seek employees with diverse backgrounds, experiences, and perspectives to better serve our community. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation, gender identity, gender expression, national origin, religion, marital status, medical condition, disability, military service, pregnancy, childbirth and related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment. Position Information Which position are you applying for? How did you hear about the position? Personal Information First Name: Last Name Address 1: Address 2: City: State: Zip: Phone: Email: If you are under 18 years of age, can you provide a work permit? Yes: No: Have you ever been employed by Alpine County? Yes: No: If yes, please list dates of employment and position: Are you currently employed? Yes: No: If yes, may we contact your employer? Yes: No: If hired, can you present evidence of US Citizenship or proof of your legal right to work in the US? Proof of citizenship or immigration status will be required upon employment. Yes: No: Are you available to work: Full Time: Part Time: Weekends: Temporary: ---PAGE BREAK--- On what date would you be available for work? Do you possess a valid driver’s license? Yes: No: Have you ever been discharged or requested to resign from a position? Yes: No: If yes, please explain circumstances and list dates: Education High School Address Diploma College Address Degree Other Address Degree Employment History Starting with your present or last job. Include any job-related military service and volunteer activities. You may exclude organizations with indicate race, color, religion, gender, national origin, handicap or other protected status. Do not attach resume in lieu of completing this section. (From most recent) Company Name Position Supervisor Phone Number May we contact your previous supervisor for a reference? Yes: No: Address Responsibilities Employed From - To (Date) Reason for Leaving ---PAGE BREAK--- Company Name Position Supervisor Phone Number May we contact your previous supervisor for a reference? Yes: No: Address Responsibilities Employed From - To (Date) Reason for Leaving Company Name Position Supervisor Phone Number May we contact your previous supervisor for a reference? Yes: No: Address Responsibilities Employed From - To (Date) Reason for Leaving Attachments: Resume Cover Letter ---PAGE BREAK--- References Please list three professional references. Name Relationship Company Phone Number Name Relationship Company Phone Number Name Relationship Company Phone Number Applicant’s Statement I certify that answers given herein, as well as all attached documents are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby understand and acknowledge that, unless otherwise defined by applicable law or written agreement executed by both employer and employee, any employment relationship with this organization is governed solely by this organization’s personnel policies and procedures, as amended from time to time. I understand that false or misleading information given in this application, supporting materials, or interview(s) may disqualify me from further consideration and if employed may result in discharge or other disciplinary measures. I understand, also, that I am required to abide by all rules and regulations of Alpine County. This application must be completed to qualify for consideration. All applications who meet the minimum qualifications are not guaranteed advancement through any subsequent phase of the selection process. Alpine County reserves the right to determine the number of best qualified applicants that may continue in the process. The process may include, but is not limited to, one or more of the following: application review, competitive screening, written examination, performance examination and/ or oral examination as well as the probationary period. By signing below, I hereby authorize the County of Alpine to inquire, verify and obtain information and documentation related to my employment history and educational institutions, for the purpose of establishing my qualifications and professional work habits as it pertains to my application for employment. Furthermore, I authorize any institution or individual to release and disclose any employment related information and documentation to the County of Alpine for the purpose of establishing my qualifications and professional work habits. Such employment related information may include but it is not limited to employment dates, job duties, rehire eligibility, salary and opinions regarding work performance. I acknowledge my employment is contingent on the disclosed employment information and hereby release and hold harmless, the County of Alpine and any individual or institution who disclosed employment related information from any liability or damage that may result from furnishing such requested information. Applicant’s Signature *