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Equal Opportunity Employer
We consider applicants for all positions without regard to race, sex, religion, sexual orientation, national origin, ancestry, color, creed, age, marital status, disability, or any other legally protected status.
First Name
Last Name
Date*
Date
Primary Contact Number*
Alternate/Cell Phone Number
Home Address*
City*
State*
Zip Code*
Email (Optional)
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Start with your present or last job. Include military service assignments, and volunteer activities. Exclude organization names which indicate race, color, religion, sex, or national origin. Resume is not a subsitute for this section.
Employer
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Address
City
State
Zip Code
Phone
Job Title
Supervisor
Reason for Leaving
Duties
Employer
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Address
City
State
Zip Code
Phone
Job Title
Supervisor
Reason for Leaving
Duties
Employer
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Address
City
State
Zip Code
Phone
Job Title
Supervisor
Reason for Leaving
Duties
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Please list name, phone number, and relationship of 3 personal references that aren't related to you.
1. Reference Name*
Phone Number*
Relationship*
2. Reference Name*
Phone Number*
Relationship*
3. Reference Name*
Phone Number*
Relationship*
List any equipment or machines you can operate that relate to the position you are applying for.
1. Equipment or Machine
2. Equipment or Machine
3. Equipment or Machine
Summarize any computer skills you acquired from past employment and list programs in which you are proficient.
Any additional information you feel may be helpful in considering your application.
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I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, including but not limited to, checking references and prior employment. I understand that this application is not intended to be a contract of employment.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all rules and regulations of the City of Solvang.
Signature of Applicant*
Date*
Date
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I understand that before the date of hire, I may be required to pass a physical examination and background investigation, which may include credit reports and I will be required to:
- Submit proof of U.S. citizenship or legal right to remain and work in the United States
- Submit proof of age
- Be fingerprinted
- Submit to drug and/or alcohol test
Signature of Applicant*
Date*
Date

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