California Public Agency — Housing Authority of the County of Merced
Email: websiteformmail@merced-pha.com (209) 722-3501 TDD: 711

Application for Employment

Housing Authority of the County of Merced — 405 ‘U’ Street, Merced, California 95341 — (209) 722-3501

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Instructions 1. Please complete all sections of this application.
2. Keep this office informed of any changes in your address or phone number.
NOTE: Applications not properly completed with all requested information will be subject to rejection.
Section 1Personal Information
Section 2General Questions
1. If employed, can you provide proof of age?
(Employment is subject to verification that applicant's age meets legal requirements. Verification must be provided within your first 3 working days.)
2. Have you ever been employed by the Housing Authority?
3. Is any member of your immediate family now employed by the Housing Authority?
(Employment may be subject to restrictions of current nepotism policy regarding the definition of “immediate family.”)
4. Were you ever discharged, rejected during a probationary period, or have you resigned under pressure of unfavorable circumstances from any employment?
5. Are you applying for veteran's preference consideration?
(If “Yes”, submit a copy of form DD-214 verifying eligible service along with your application BEFORE the final filing date.)
6. Languages in addition to English you speak or write well enough to act as interpreter:
7. Do you possess a VALID California driver's license?
8. Are there any hours, shifts, or days you cannot or will not work?
9. Are you legally eligible for employment in the United States?
(Successful candidate will be required to provide proof of identity and eligibility for employment within 3 days of beginning employment.)
10. If selected, on what date will you be available for work?
Section 3Education and Experience

High School

College / University

College 1

College 2

Trade / Business School

Section 4Employment Experience

Fill out ALL AREAS below. List each job held. Start with your PRESENT or last job. Include military and volunteer activities.

DO NOT MERELY ATTACH A RESUME WITH A NOTATION TO “SEE ATTACHED RESUME”.

Employer 1 (Most Recent)

Employer 2

Employer 3

Section 5Additional Qualifications

Special Licenses, Certificates, or Honors

Equipment Experience

Computer Software Proficiency

Section 6Certification
I hereby authorize investigation of all statements as provided by me in this application as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract or offer of employment. In the event I am subsequently employed, I understand that false or misleading information given in my application or interview(s) may result in discharge. I further certify that the answers given herein are true and complete to the best of my knowledge.