Page 130 - SAC - DPW - AMB 09 05 19

EMPLOYMENT APPLICATION
CITY OF SACRAMENTO Received: __________________
915 I Street, Historic City Hall
Sacramento, California 95814-2604
(916) 808-5726
https://www.cityofsacramento.org/HR

QUESTIONS WITH AN * REQUIRE A RESPONSE. YOUR APPLICATION MAY NOT BE CONSIDERED IF INCOMPLETE.
JOB INFORMATION
* JOB POSTING NUMBER: * POSITION TITLE:
Director of Public Works

PERSONAL INFORMATION
* FIRST NAME MIDDLE INITIAL * LAST NAME

Mohammad A Qureshi
* ADDRESS

2308 Willard Ave
* CITY * STATE * ZIP

Tustin CA 92782
HOME PHONE ALTERNATE PHONE

601-503-8039
* WHICH METHOD DO YOU PREFER TO BE NOTIFIED ABOUT YOUR
* EMAIL ADDRESS APPLICATION STATUS? EMAIL OR PAPER

drmoque@gmail.com

EDUCATION

WHAT IS YOUR HIGHEST LEVEL OF EDUCATION:
Some High School Some College Associate’s Degree Master’s Degree
High School Technical College Bachelor’s Degree Doctorate

LEGAL RIGHT TO WORK
CAN YOU, AFTER EMPLOYMENT, SUBMIT PROOF OF YOUR LEGAL RIGHT TO WORK IN THE UNITED STATES? YES NO

EDUCATION
SCHOOL NAME DEGREE RECEIVED
University of California Bachelor of Science
SEMESTER QUARTER
SCHOOL LOCATION (CITY/STATE) DID YOU GRADUATE? # OF UNITS COMPLETED:

Berkeley, CA YES NO
MAJOR
Civil Engineering

SCHOOL NAME DEGREE RECEIVED
University of California Master of Science
SEMESTER QUARTER
SCHOOL LOCATION (CITY/STATE) DID YOU GRADUATE? # OF UNITS COMPLETED:

Berkeley, CA YES NO
MAJOR
Civil Engineering

SCHOOL NAME DEGREE RECEIVED
University of Tennessee Ph.D.
SEMESTER QUARTER
SCHOOL LOCATION (CITY/STATE) DID YOU GRADUATE? # OF UNITS COMPLETED:

Knoxville, TN YES NO
MAJOR
Civil Engineering

DRIVER’S LICENSE INFORMATION
STATE WHERE
* IF THE POSITION INVOLVES DRIVING, DO YOU HAVE A VALID LICENSE? YES NO ISSUED CLASS

CA C

CERTIFICATES & LICENSES
TYPE DATE ISSUED (MONTH/YEAR) EXPIRATION DATE (MONTH/YEAR)
Professional Engineer in Civil 7-27-2009 12/31/2019
LICENSE NUMBER ISSUING AGENCY
C75297 California Board for Professional Engineers, Land Surveyors, and Geologists

TYPE DATE ISSUED (MONTH/YEAR) EXPIRATION DATE (MONTH/YEAR)
Professional Engineer in Traffic 1-16-2009 6/30/2021
LICENSE NUMBER ISSUING AGENCY
TR2542 California Board for Professional Engineers, Land Surveyors, and Geologists