San Mateo County Mosquito and Vector Control District Employment ApplicationPosition(s) applied for (required)Seasonal Vector Control Aide I/IISeasonal Public Health Education and Outreach AssistantName (required)Street address (required)City, State, and Zip Code (required)Daytime phone number (required)Email Address (required)Do you possess a valid California driver's license? (required)YesNoDriver's license numberDriver's license expiration dateAre you age 18 or older? (If under 18, a work permit is required by state/federal law) (required)YesNoIf you are not a U.S. Citizen, do you have the legal right to work in the United States? (required)YesNoHave you ever served in the military service of the U.S.? (required)YesNoIf yes, which branch?List areas of special interest or abilities.Education/AbilitiesSelect the highest level of education you have completed.Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11High school diploma or GED certificateCollege or university degreeGraduate or professional degreeFor all colleges/universities attended, please list your degree, major, minor, years completed, and units or hours completedList apprenticeship, trade, vocational, business school or any other special training you have had. Include type, where acquired, dates, whether completed and any other applicable informationList any special skills or experience relevant to the job applied for (e.g. operating machinery, etc.)Are you fluent in any language(s) other than English?YesNoIf yes, please specify which language(s) and your abilities to speak, listen/understand, write, and read the language(s).List the names and phone numbers of three references: (required)Probable date available to start employmentSpecify any hours or days you cannot or will not work.Can you perform the essential requirements of the positions for which you are applying, with or without reasonable accommodation? (Note: The District complies with the ADA and state law and considers reasonable accommodation measures that may be necessary for eligible applicants and employees to perform essential functions.)YesNoPrevious positions - Begin with your present job and list in reverse order. Include self-employment or any periods of unemployment in excess of one month. List any promotions as a separate job.Present job - include dates employed, job title, job responsibilities, name and address of employer, supervisor name and phone number, reason for leavingPrevious job 1 - include dates employed, job title, job responsibilities, name and address of employer, supervisor name and phone number, reason for leavingPrevious job 2 - include dates employed, job title, job responsibilities, name and address of employer, supervisor name and phone number, reason for leavingPrevious job 3 - include dates employed, job title, job responsibilities, name and address of employer, supervisor name and phone number, reason for leavingState any additional information you feel may be helpful in considering your application.Please read carefully, and enter your initials for each item.I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed. (required)I hereby authorize the District to thoroughly investigate my references, work record, education and other matters related to my suitability for employment. (required)I hereby authorize the District to allow potential screening, procedures, and/or the procurement and investigation of records including but not limited to the categories of immigration status, military discharge, criminal record, drug testing, (mandatory for safety-sensitive positions such as jobs requiring driving a motor vehicle or operating machinery), physical exams, fingerprinting, department of motor vehicle records, educational transcripts and credit history for positions in the Finance Department. Any additional areas of screening and investigation that may become necessary must be disclosed by the District and agreed to by the candidate in writing. Refusal by me to allow any screening or investigation required by the District in accordance with this policy shall constitute a basis to discontinue the employment application process. (required)I understand that nothing in the application, or conveyed during any interview for employment, or conveyed at any time during my employment, if hired, is intended to create an employment contract between the District and me. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the District, and that no promises or representations contrary to the foregoing are binding on the District unless made in writing and signed by me and the District's authorized representative. (required)Please enter your full name and date indicating you understand the following:I understand and agree that my employment with the San Mateo County Mosquito and Vector Control District is for no specific period of time and may be terminated by either party. I certify that the information contained in this application and any attachments I provide is correct and complete to the best of my knowledge. I agree to have any of the statements checked by the company. I authorize my references and supervisors, past and present, to provide information concerning my employment history. I release all parties from any and all liability for damages that may result from furnishing such information, as well as from the use of or disclosure of such information by the District or its agents. I understand that any misrepresentations or material omissions may result in my failure to receive an offer or, if I am hired, in my dismissal. Name and date: (required)There was a problem saving your submission. Please try again later.Please wait while your submission is being saved...Submitting...SubmitThank you, your submission has been received. After submitting the online application, if applicable, submit your cover letter and resume via email to info@smcmvcd.org
