Supplemental Information

I hereby certify that the statements provided herein are true and complete to the best of my knowledge. I understand that false or misleading statements or information may result in my disqualification as an applicant or subsequent discharge as an employee.

Applicants do not have to complete this part to be considered for employment. This information is being collected for statistical purposes only. Your answers will not affect the hiring process or hiring decisions. The Housing Authority of the County of Merced does not discriminate in matters of employment because of race, color, national origin, marital status, sex, religion, age or handicap.

As noted in this job announcement packet, this recruitment process includes a background check of all applicants for employment with the Housing Authority. While we normally utilize the employer information contained in the “Employment Experience” section of the application, many times this information is not current or sufficient for us to make a reasonable inquiry.

As our decision regarding an applicant’s status cannot be completed without sufficient investigation, please provide the following references in addition to any you have listed within the “Employment Experience” section of the application. Failure to fill out either the Employment Experience section of the application, or this form, will result in your application being declared “Incomplete.” References listed on this form can be persons who have worked with you, in recent past or current employment situations. They should be persons for whom you can provide a current mailing address and/or phone number to enable us to contact them in a timely manner.

Prior to furnishing their personal information to the Housing Authority, you should contact your references and advise them of your intent to include them as a background resource. Both yourself and your references should understand that failure to respond to a background inquiry within a specified timeframe may compromise your ability to be considered as a finalist for the position. Information provided by your references will be maintained as confidential to the full extent allowed by law.