CERTIFICATED EMPLOYMENT APPLICATION
Human Resources Services
44711 North Cedar Avenue
Lancaster, California 93534
Position(s) for which you are applying (Grade and/or Subject)
Social Security Number
Education and Professional Training
Institution of Higher Education
Semester units of graduate work beyond BA or BS degree (1-Quarter Unit equals 2/3 Semester Unit)
BA+45 or MA
MA+15 or BA+60
MA+30 or BA+75
Awards, Honors, Scholarships, etc., which you feel relate to this position:
What languages other than English can you speak?
List extra-curricular activities you participated in college.
List Professional, Technical, Educational, Community, or Service Organizations to which you belong.
(Omit religious, racial, or ethnic organizations)
Please complete the following fitness questions. If you answer “yes” to any question, please attach a
full explanation using a separate sheet of paper.
Have you ever been dismissed, retired, resigned from, suspended for more than ten
days, or otherwise left school employment because of allegations of misconduct?
Have you ever been convicted, including a conviction based on a plea of no contest,
of any felony or misdemeanor in California or any other place?
Have you ever been or are you currently the subject of any inquiry or investigation by
any licensing agency or law enforcement agency (in California or any other state)?
Have you ever been convicted of any moving traffic violations?
Are any criminal charges currently pending against you?
Is any disciplinary acti