Free Employment Application - California

SU PERIOR COUR T OF CA LIFORN IA COUN TY OF MENDOCINO
Mendocino County Courthouse Human Resources 100 North State Street, Room 303 Ukiah, CA 95482 (707) 463-4285 FAX (707) 468-3459 Job Line: (707) 467-2544 Website: www.mendocino.courts.ca.gov

PLEASE NOTE: · A separate application is required for each examination. · Type or print in ink when you mail or drop off your application · Incomplete or illegible applications will not be considered. · Fill in this application on your computer, then print, fax or E-mail this document. Application must be signed prior to exam or interview.

EMPLOYMENT APPLICATION

It is your responsibility to keep the Superior Court of California, County of Mendocino, informed of any change of address or telephone number.

GENERAL INFORMATION
Position Applying For: Your Name: Mailing Address: Telephone Number Last Number and Street/PO Box Home Number Business Number Ext. First City Middle State ZIP Code

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Yes

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No

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E-mail Address: Yes No

May we contact you at your business number?

May we contact your current employer? Yes No

Can you, after employment, submit proof of your legal right to work in the United States? Are you 18 years of age or over? Yes No

Veterans check here if you're applying for Veteran's Preference Points:

Attach copy of Form DD214 to application.

Veteran's preference points are given to eligible veterans on certain recruitments. Refer to the recruitment announcement to see if veteran's preference points are applicable to the specific recruitment. *If Yes, give date and nature of the offense below. (Convictions are evaluated for each position and are Have you ever been convicted of a felony by any court? Yes* No not necessarily disqualifying). Do you have a valid California driver's license? Yes No

Class

Number

What language(s) other than English, do you speak fluently? Read or Write fluently? Important: Employment with the Court may require transfer to other than original applying area. In accepting employment with the Court, you are consenting to such transfer. Indicate types of appointment(s) you will accept: Full time regular position (40 hours per week) Part time regular position (fewer than 40 hours per week, benefits provided are prorated to hours worked) Extra Help (Hourly, On-call, Fill In, non-benefited) Have you ever been discharged or rejected during probation, or resigned under pressure or unfavorable circumstances Yes* No *If Yes, explain on additional sheet.

TURN PAGE TO CONTINUE COMPLETING APPLICATION

FOR COURT HUMAN RESOURCES USE ONLY
Date Reviewed Vets Points Reviewer Type Speed Rejected Accepted Trans Speed Education Mail Date Experience Too Late Certification Bilingual License Other

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EDUCATION: Did you graduate from high school?

Yes

No

If "NO", what was the highest grade completed: If "NO", did you receive a G.E.D.? Yes No

Undergraduate, Business, or Trade School

Major Major Major

Semester Units Completed Semester Units Completed Semester Units Completed

Quarter Units Completed Quarter Units Completed Quarter Units Completed

Type of Degree Year Conferred Type of Degree Year Conferred Type of Degree Year Conferred

EXPERIENCE: Please give us enough information to allow for review and evaluation of your work experience. List the positions you have held starting with your most recent job. Include any relevant volunteer experience. If you were employed under another name, write in the name by which you were known to your employer. A resume may be attached but will not be accepted in place of this section. Applications received that do not have the Experience section completed will be rejected as incomplete.
Dates of Employment To
MO / YR MO / YR

Employer Title of your position Type of Work Performed (Be Specific)

Address # Employees Supervised By you

City Supervisor's Name and Phone Number

State

ZIP

Hours Per Week Salary $ Reason for leaving Dates of Employment To
MO / YR MO / YR

Employer Title of your position Type of Work Performed (Be Specific)

Address # Employees Supervised By you

City Supervisor's Name and Phone Number

State

ZIP

Hours Per Week Salary $ Reason for leaving Dates of Employment To
MO / YR MO / YR

Employer Title of your position Type of Work Performed (Be Specific)

Address # Employees Supervised By you

City Supervisor's Name and Phone Number

State

ZIP

Hours Per Week Salary $ Reason for leaving

REFERENCES: Give names and addresses of three people, not relatives, that we may contact who have knowledge of your job skills experience and ability. You may use past employers.
Name Address Telephone Number ( ) ( ( ) ) Business/Occupation

Applicant Certification: PLEASE READ BEFORE SIGNING: I CERTIFY that the statements made by me in this application are true, complete, and correct to the best of my knowledge and belief. I understand that statements made are subject to verification and that any misrepresentation, fraud, or omission of facts may be grounds to deny Court employment or for disciplinary action including dismissal after employment. X___________________________________________________________________________ Signature
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________________________________________ Date

MISCELLANEOUS INFORMATION Fidelity Bonds
Have you ever been bonded? Have you ever been denied a bond? Are you presently bondable: Yes Yes Yes No No No Yes Give dates and details: Give dates and details: I don't know No

Do you have the legal right to work in the United States?

The Superior Court of California, Mendocino County, hires only U.S. citizens and aliens authorized to work in the United States. All new employees will be required to complete an I-9 form and provide documentation establishing identity and employment eligibility within three (3) days of hire. Are you able to perform the essential functions of the job for which you are applying based on the job announcement with or without reasonable accommodations? Yes No The Superior Court of California, Mendocino County, will make efforts to provide reasonable accommodations to disabled candidates in the examination process. If you have special needs, please notify staff at the Superior Court of California Human Resources Office by the filing date by calling 707-463-6815.

Have you ever applied for this position before?

Yes

No Yes Yes No. No.

Have you ever been employed by the Superior Court of Mendocino County? Do you have any relatives employed by the Superior Court of Mendocino County? If yes, indicate names/relationship:

RECRUITMENT INFORMATION
Name (please print): Position Applied For:

Please complete the following: I first learned of the job opening through (check one): Court Employment Opportunities list, job announcement Newspaper ad Trade or professional publication ______________________

School placement office Organization or group_________________ Other Friend or relative

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IMPORTANT NOTICE TO APPLICANTS:
GO BACK AND REVIEW THIS APPLICATION. MAKE SURE ALL QUESTIONS ARE ANSWERED. ONLY COMPLETED APPLICATIONS CAN BE CONSIDERED. CERTIFICATION: I hereby certify that all statements made on this application are true and complete to the best of my knowledge. I understand that any false, incomplete or incorrect statement may result in my disqualification from the examination process or dismissal from employment with the Superior Court of California, Mendocino County, if I am employed. I authorize the Superior Court of California, Mendocino County, to investigate my references, work record, education or any other matters relating to my suitability for employment. I authorize my former or current employers and educational institutional to release any information they may have concerning my employment or education, to the Superior Court of California, Mendocino County. I specifically authorize the Superior Court of California, Mendocino County, to use my Driver's License information (if required as part of this application) to conduct a driving record check with the Department of Motor Vehicles. I further give the Superior Court of California, Mendocino County, the right to secure additional information from any source as necessary including, but not limited to, a criminal history record check. I release any and all sources of information from any liability for providing this information. I understand that if I am employed, I will be required to abide by all rules, regulations, and policies of the Superior Court of California, Mendocino County. I also understand that I will be required to abide by all the tenets of the Code of Ethics for the Court Employees of California. I declare, under penalty of perjury, that all information is correct.

Name (please print): _____________________________________________________________

Signature of Applicant (Sign in Ink)

Date

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SU PERIOR COUR T OF CA LIFORN IA COUN TY OF MENDOCINO An Equal Opportunity Employer
To help us carry out our EEO obligations, please indicate if any of the following definitions apply to you. Vietnam Era Veteran. A person who (1) served on active duty for a period of more than 180 days any part of which occurred between 8/5/64 and 5/7/75, and discharged or released there from with other than a dishonorable discharge, or (2) was discharged or released from active duty for service connected disability if any part of such active duty was performed between 8/5/64 and 5/7/75. Disabled Veteran. A person entitled to disability compensation under law as administered by the Veteran's Administration for disability rated at 30 percent or more or a person whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty. Person with a Disability. A person who (1) has a physical or mental impairment which substantially limits one or more of such person's major life activities, (2) has a record of such impairment or (3) is regarded as having an impairment. We wish to accommodate otherwise qualified handicapped applicants. What is the nature of your disability? Visual Hearing Speech Physical Development disability

If you require special testing arrangements because of a physical disability please contact the Superior Court Human Resources Department prior to the test date so we can accommodate you. Yes No Will you require such accommodation? Please help us comply with the state and federal law by completing this section. While you are not required to complete this section, you should know that if you leave it blank we have the right to enter data for this purpose based upon our visual assessment. To demonstrate that we meet equal employment opportunity requirements, periodically we must report statistical information about applicants and employees to the California and United States governments. This information will be kept separate and confidential and will not be used in any unlawful way to make any employment decision. Your date of Birth Mo Day Yr Check appropriate box : Male Female

Please answer below based upon how you are known in your community. We understand that it may be difficult to choose a single ethnic identity if you have a multicultural heritage. Nevertheless to comply with legal guidelines we would like you to choose only one. White (not Hispanic Origin): All persons not classified into one of the five specific ethnic minority categories that follow. Asian or Pacific Islanders other than Filipinos. All persons having origins In any of the original peoples of the Far East, Southeast Asia, or the Pacific Islands. For example, include China, Japan, Korea, Samoa, theIndian Subcontinent and in the Middle East. Black (not Hispanic Origin) All persons having origin in any of the black racial groups Filipino. All persons having origins in the peoples of the Philippine Islands. Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. American Indian or Alaskan Native. All persons having origins in any of the original Peoples of North America.

Name (Please print or type) Position Applied For: Signature Date

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