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HUMAN RESOURCES 10890 SAN PABLO AVENUE EL CERRITO, CA 94530 (510) 215-4315 [EMAIL REDACTED] EL CERRITO STARS INTERN PROGRAM APPLICATION (PLEASE PRINT IN BLUE OR BLACK INK) THE CITY OF EL CERRITO IS AN EQUAL OPPORTUNITY EMPLOYER AND ALL EMPLOYMENT DECISIONS WILL BE APPLIED EQUALLY AND ARE BASED UPON THE NEEDS OF THE CITY SERVICE, JOB RELATED MERIT, AND ABILITY TO PERFORM THE JOB. EL CERRITO PROVIDES APPLICANTS WHO HAVE DISABILITIES WITH REASONABLE ACCOMMODATIONS TO ASSIST IN THE INTERVIEW/HIRING PROCESS. APPLICANTS REQUIRING ACCOMMODATIONS SHOULD CONTACT THE HUMAN RESOURCES DIVISION AT (510) 215-4315. EL CERRITO IS DRUG/ALCOHOL-FREE AND SMOKE-FREE WORKPLACE. THIS DOCUMENT MUST BE COMPLETED IN ITS ENTIRETY BEFORE AN OFFER OF EMPLOYMENT CAN BE AUTHORIZED. PERSONAL DATA NAME (LAST) (FIRST) (MIDDLE) TODAY’S DATE ADDRESS (NUMBER) (STREET) (APARTMENT HOME TELEPHONE ( ) ALTERNATE P HONE ( ) CITY STATE ZIP CODE SOCIAL SECURITY NUMBER (REQUIRED) EMAIL ADDRESS: DATE OF BIRTH: / / EL CERRITO REQUIRES THAT EL CERRITO HIGH STUDENTS SELECTED FOR THE PROGRAM ARE 16 YEARS OF AGE. ARE YOU PRESENTLY 16 YEARS OF AGE OR OLDER? YES NO IF “NO”, WILL YOU BE 16 BEFORE JUNE 1 ST? YES NO EMERGENCY CONTACT PERSONS (NAME, RELATIONSHIP AND TELEPHONE NUMBER) 1) 2) HAVE YOU EVER BEEN EMPLOYED BY THE CITY OF EL CERRITO? YES NO IF YES, NAME OF DEPARTMENT WHEN WHERE POSITION HELD NAME USED ARE YOU OR HAVE YOU EVER BEEN A VOLUNTEER FOR THE CITY OF EL CERRITO? YES, WHEN: WHERE: DO YOU HAVE RELATIVES WORKING FOR THE CITY OF EL CERRITO? IF YES, INDICATE RELATIONSHIP AND DEPARTMENT YES NO IF HIRED, YOU WILL BE REQUIRED TO FURNISH PROOF THAT YOU ARE LEGALLY AUTHORIZED TO WORK IN THE UNITED STATES. CAN YOU FURNISH SUCH PROOF? YES NO REFERENCES (NON-RELATIVES) NAME TELEPHONE NUMBER HOW DOES THIS PERSON KNOW YOU OCCUPATION NAME TELEPHONE NUMBER HOW DOES THIS PERSON KNOW YOU OCCUPATION EDUCATION INFORMATION COUNSELOR’S NAME GRADE YOU WILL COMPLETE THIS YEAR ARE YOU A STUDENT IN THE MEDIA ACADEMY AT ECHS? YES NO ARE YOU A STUDENT IN THE IT ACADEMY AT ECHS? YES NO ---PAGE BREAK--- HUMAN RESOURCES 10890 SAN PABLO AVENUE EL CERRITO, CA 94530 (510) 215-4315 [EMAIL REDACTED] EMPLOYMENT / VOLUNTEER / LEADERSHIP EXPERIENCE LIST CURRENT AND PREVIOUS WORK EXPERIENCE (INCLUDE VOLUNTEER WORK AND/OR LEADERSHIP ACTIVITIES) COMPANY NAME / ADDRESS / DATES EMPLOYED JOB TITLE AND DUTIES PERFORMED FROM: TO: TITLE: DUTIES: FROM: TO: TITLE: DUTIES: FROM: TO: TITLE: DUTIES: INTERN OPPORTUNITIES PLEASE LIST YOUR TOP THREE CHOICES USING THE LIST OF INTERN OPPORTUNITIES BELOW. WE WILL DO EVERYTHING WE CAN TO MATCH YOU WITH ONE OF YOUR TOP CHOICES, BUT THIS IS NOT A GUARANTEE. • RECREATION • FIRE • PLANNING • PUBLIC WORKS • FINANCE • CITY MANAGEMENT • HUMAN RESOURCES 1 ST CHOICE 2 ND CHOICE 3 RD CHOICE LANGUAGE PROFICIENCY (OTHER THAN ENGLISH) LANGUAGE READS WRITES SPEAKS AMERICAN SIGN LANGUAGE (SIGN) YES NO SKILLS COMPUTER SKILLS TYPE OF SOFTWARE USED (CHECK ALL THAT APPLY): INDICATE SKILL LEVEL: BEGINNING INTERMEDIATE OR ADVANCED EXCEL WORD POWERPOINT ACCESS ADOBE PHOTOSHOP OTHER: OTHER (LIST OTHER SKILLS): ATTACHMENTS TO THE EMPLOYMENT APPLICATION I HAVE ATTACHED THE FOLLOWING INFORMATION TO THE APPLICATION: 1) A PERSONAL STATEMENT(500 WORDS OR LESS) DESCRIBING YOUR INTEREST IN WORKING FOR THE CITY AND WHAT YOU HOPE TO GAIN FROM THE PROGRAM YES NO 2) AT LEAST ONE LETTER OF RECOMMENDATION FROM AN ADVISOR, COUNSELOR OR YOUR IT/MEDIA ACADEMY TEACHER OR COORDINATOR YES NO 3) COVER LETTTER AND RESUME (OPTIONAL) YES NO 4) “PARENT PERMISSION FORM” (FOR STUDY TRIP TO ATTEND JOB INTERVIEW) YES NO APPLICANT STATEMENT I CERTIFY THAT THE ANSWERS I HAVE PROVIDED ABOVE ARE TRUE, CORRECT AND COMPLETE AND THAT I HAVE NOT KNOWINGLY WITHHELD ANY FACTS. I UNDERSTAND ANY FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACTS ARE SUFFICIENT REASONS FOR DISQUALIFICATION FROM FURTHER CONSIDERATION FOR EMPLOYMENT OR DISMISSAL AT ANY TIME DURING EMPLOYMENT SHOULD I BECOME EMPLOYED AT THE CITY OF EL CERRITO. I ALSO UNDERSTAND THAT IF I AM EMPLOYED BY THE CITY OF EL CERRITO, MY EMPLOYMENT CAN BE TERMINATED AT ANYTIME WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE. I UNDERSTAND THAT A COPY OF THIS DOCUMENT IS AVAILABLE TO ME IF I SO DESIRE. APPLICANT’S SIGNATURE: DATE: