Employment Application Step 1 of 7 - Applicant Information 14% Name* First Last Date* Address* Street Address Apt/Unit # City State Zip Code Phone*Email* Position applying for (1 Position per application)*Are you a citizen of the United States*YesNoHave you ever been discharged or resigned*YesNoIf Yes, please explainDo you read & write in any language(s) other than English*YesNoWhat language(s) High School*Address* Street Address City State Zip Code From* To* Did you graduate High School?* Yes No CollegeAddress Street Address City State Zip Code From To Did you graduate College?* Yes No DegreeOther EducationAddress Street Address City State Zip Code From To Did you graduate? Yes No Degree Please list three professional referencesName* First Last Relationship*Company*Phone*Address* Street Address City State Zip Code Name* First Last Relationship*Company*Phone*Address* Street Address City State Zip Code Name* First Last Relationship*Company*Phone*Address* Street Address City State Zip Code Resume may be attached but will not substitute for completing this section.CompanyPhoneAddress Street Address City State Zip Code SupervisorJob TitleResponsibilitiesFrom To Reason for leavingMay we contact your previous supervisor for a reference* Yes No Additional SkillsList any school courses, special skills, training, machines or equipment you can operate, which relate to the requirements of this positionResume*Other Required Documents per Job Description Applicants with Disabilities. If you require special testing arrangements, please contact the Personal office when you submit your application. Reasonable effort will be made to accommodate your needs. After reviewing the job description are you in need of any special accommodations in order to perform the essential functions of this position Yes No The Housing Authority of the County of Stanislaus does not discriminate on the basis of handicap in admission or access to, its housing assistance programs or in its employment practices, in Violation of 24 CFR Part 8. It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, or other protected classification, and to maintain a drug free workplace. This application is part of the examination process. Failure to meet all the requirements presented in the announcement by the final filling date is cause for rejection. All application data is due by 5:00 p.m. on the announced closing date for the position. I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I agree to submit to a complete physical exam which will include a drug/alcohol test and to furnish such proof of age and citizenship as may be required by law.Signature*Date* This information is requested in accord with State and Federal requirements. This information is voluntary and will not be retained with your application, but handled separately for statistical purposes. Thank You. How did you learn about this job opening? (Check one or more)* Newspaper Trade Journal Friend or Relative Housing Authority Employee Internet Website Job announcement on a bulletin board Other The U. S. Department of Housing and Urban Development (HUD) monitors our hiring practices on “Section 3” funded projects. It is important, therefore, that the information below be provided. Please be aware that your response, though needed, is voluntary and has no affect on your employment status. Because these questions are personal in nature, your answers will be treated with confidentiality. Thank you for assisting us. Sincerely, The Housing Authority Name First Last Address Street Address Apt/Unit # City Sate Zip Code Number of individuals living in your household (include yourself)Please enter a number from 1 to 20.Are you currently employed*YesNoI certify that the statements made on this sheet are true, complete and correct to the best of my knowledge and belief, and made in good faith. Date Signature This iframe contains the logic required to handle Ajax powered Gravity Forms.