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Corning, CA
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Human Resources
Job Application Form
Job Application Form
Date of Application:
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Required
MM slash DD slash YYYY
Position Applied For:
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Required
Rate of Pay Expected:
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Name
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First
Middle
Last
Email
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Required
Address
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Required
Street Address
City
State / Province / Region
ZIP / Postal Code
Mailing Address (If different from above)
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
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Required
Is it OK to leave message?
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Yes
No
Are you a U.S. Citizen?
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Required
Yes
No
If not, are you a legal resident?
Yes
No
Drivers License
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Required
Number
Class
State Issued
Expiration Date
Were you previously employed by the City of Corning?
Yes
No
If yes, when and under what name?
Do you have any relatives working for the City of Corning?
First
Last
Relationship
Do you type?
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No
WPM:
Do you possess any licenses, permits, certificates, or any experiences, skills or qualifications which would be applicable for work with the City? Please list any foreign languages(s) in which you are fluent.
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Education History:
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Check all that apply
Graduated High School
Some College
Graduated College
Graduated Other/Business/Trade
Education Details:
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Please specify educational institution(s) attended. If degree earned, please specify type.
List below all present and past employment FOR THE LAST 10 YEARS beginning with your most recent job
Company Name
Start Date
MM slash DD slash YYYY
End Date
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Company Address
Street Address
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Company Phone #
Your Supervisor
First
Last
Position Held
Your Duties
Reason For Leaving
Company Name
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Company Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Company Phone #
Your Supervisor
First
Last
Position Held
Your Duties
Reason For Leaving
Company Name
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Company Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Company Phone #
Your Supervisor
First
Last
Position Held
Your Duties
Reason For Leaving
May we contact your employers listed?
*
Required
Yes
No
Which ones would you like to exclude from contacting?
Resume and/or References: (upload option)
Max. file size: 25 MB.
BY CLICKING THE BOX BELOW, I HEREBY CERTIFY THAT MY ANSWERS TO THE QUESTIONS IN THIS APPLICATION ARE COMPLETE, ACCURATE AND TRUE TO THE BEST OF MY KNOWLEDGE. I AGREE AND UNDERSTAND THAT ANY OMISSION OR MISSTATEMENTS OF MATERIAL FACTS CONTAINED IN THE APPLICATION MAY CAUSE ME TO FORFEIT ALL RIGHTS OF EMPLOYMENT. I UNDERSTAND THAT THE INFORMATION PROVIDED BY ME WILL BE VERIFIED AND THAT FAILURE TO COMPLETELY ANSWER ANY QUESTION MAY RESULT IN MY NOT BEING CONSIDERED FOR EMPLOYMENT. THE CITY OF CORNING IS AN EQUAL OPPORTUNITY PROVIDER AND EMPLOYER.
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