C:\Documents and Settings\stevem.FILLMORE\Desktop\employment application.01.2008.doc
APPLICATION FOR EMPLOYMENT
CITY OF FILLMORE, CALIFORNIA
NAME _______________________________________________________
POSITION APPLIED FOR________________________________________
DATE ________________________________________________________
Please answer all questions correctly and accurately. All statements in your application are subject to
verification. An incorrect statement may bar or remove you from employment. Applications may be filed at
Fillmore City Hall, or may be mailed to the ADMINISTRATIVE SERVICES MANAGER at:
CITY OF FILLMORE
250 CENTRAL AVENUE
FILLMORE, CA 93015
C:\Documents and Settings\stevem.FILLMORE\Desktop\employment application.01.2008.doc
PERSONAL INFORMATION
________________________________________________________________________________
Last Name
First
Initial
Position Applied for
________________________________________________________________________________________
Mailing Address
City
State
Zip
_________________________
________________________
__________________________
Home Telephone
Mobile or Work Telephone
Social Security Number
The age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with
respect to individuals who are at least 40 but less than 70 years of age.
Are you at least 18 years of age?
□YES □NO
If selected, can you provide proof of your legal eligibility to work in the United States?
□YES □NO
Do you know anyone in our employ?
□YES □NO
Name: ___________________________________________ Dept: ________________________
Name: ___________________________________________ Dept: ________________________
Have you ever been convicted of a crime in the last 7 years?
□YE