Page 71 - SAC - DYPCE - AMB 04 11 19

SKILLS

OFFICE SKILLS TYPING (NET WORDS PER MINUTE) DATA ENTRY (NET WORDS PER MINUTE)
65

OTHER SKILLS
SKILL SKILL LEVEL EXPERIENCE (YEARS OR MONTHS)
Microsoft Word, Excel BEGINNER SKILLED EXPERT 15 years
SKILL SKILL LEVEL EXPERIENCE (YEARS OR MONTHS) AGENCY WIDE QUESTIONS
BEGINNER SKILLED EXPERT The purpose of the following questions is to provide us with statistics needed to evaluate our recruitment program as well as to prepare statistical reports
required by Federal, State and local agencies. The information obtained also includes additional job related information, such as your preference of work
SKILL SKILL LEVEL EXPERIENCE (YEARS OR MONTHS) hours and locations, to better evaluate you for the position for which you are applying.
BEGINNER SKILLED EXPERT QUESTIONS WITH AN * REQUIRE A RESPONSE. YOUR APPLICATION MAY NOT BE CONSIDERED IF INCOMPLETE.
* FORMER LAST NAME, IF APPLICABLE (List Only One; Leave Blank If None): * MONTH/DAY OF BIRTH:

LANGUAGES OTHER THAN ENGLISH THAT YOU ARE PROFICIENT IN Sorlie 1/25/1974
YOUR AGENCY WIDE QUESTIONS HERE (IN THE SAME ORDER THE APPEAR ON THE ONLINE VERSION):
LANGUAGE LANGUAGE
SPEAK READ WRITE SPEAK READ WRITE * 1. ARE YOU CURRENT GOVERNMENT EMPLOYEE (EXCLUDES TEMPORARY STATUS)? YES NO
ADDITIONAL INFORMATION 2. GENDER: MALE FEMALE
Clinical Experience, Honors & Awards, Interests & Activities, Military Service, Personal, Professional Associations, Professional Memberships, Publications, 3. AGE GROUP: UNDER 17 18-20 21-39 OVER 40
Technical, Volunteer Experience, Other/Miscellaneous
Member of California Park & Recreation Society, & National Recreation & Parks Association. San Mateo 4. ETHNICITY: WHITE: Origins in any of the original peoples of Europe, North Africa, or the Middle East (not of Hispanic origin).
x
W
County Volunteer of the year,1997. 2013- Awarded Best of the Best- Volunteer Program, Adopt-a-Park I AMERICAN INDIAN OR ALASKAN NATIVE: Origins in North America or if maintain tribal affiliations through membership, participation or community recognition.
ASIAN OR PACIFIC ISLANDERS: Origins in the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands.
A
& PLAY Program. 2015-Lead CPRS Park Tour for Sacramento Region. 2017 Presenter at CPRS B BLACK: Origins in any of the Black African racial groups (not of Hispanic origin).
Session titled: Place making in Parks with Business Districts. H HISPANIC: Origins in Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin regardless of race.
MULTI-RACIAL: Combination of two or more of the above
M
* 5. PLEASE INDICATE WHICH LOCATION(S) YOU ARE WILLING TO WORK: (CHECK ALL THAT APPLY)
REFERENCES LOCATION A LOCATION D LOCATION G
LOCATION H
LOCATION E
LOCATION B
Please list references you wish to include (Personal/Professional). Please include: Name, title, phone number, email, and mailing address. LOCATION C LOCATION F LOCATION I
Professional:Dave Mitchell, Director Sunrise Recreation & Park District, 916 725-1585 * 6. PLEASE INDICATE WHICH HOURS YOU ARE WILLING TO WORK: (CHECK ALL THAT APPLY)
dmitchell@ sunriseparks.com 7801 Auburn Blvd. Citrus Heights, Ca. 95610 FULL TIME PART TIME TEMPORARY FULL TIME TEMPORARY PART TIME VOLUNTEER INTERNSHIP
Personal: Kathleen Beltrano, Special Events Permitting Specialist, National Park Service 650-823-9537 * 7. HOW DID YOU LEARN ABOUT THIS POSITION? (PLEASE CHECK ONE)
Agency Website
katiebeltrano@ earthlink.net 118 Paloma Ave. Pacifica, Ca. 94044 Called or Visited
Community Newspaper
JOB HOTLINE
Educational Institution
Friend/Relative
ETC
APPLICANT DECLARATIONS
I certify that all statements in this application are true and complete. I agree and understand that any misstatements or * 8. WILL YOU BE LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE UNITED STATES AT THE TIME OF A POTENTIAL JOB OFFER? YES NO
omissions of material facts herein will cause forfeiture on my part of all rights to employment by the City of *9. DURING THE PAST 7 YEARS HAVE YOU BEEN CONVICTED OF A MISDEMEANOR, GROSS MISDEMEANOR OR FELONY FOR WHICH A JAIL SENTENCE
Sacramento. I understand that if I do not meet the announced requirements, I will be eliminated from the examination WAS OR COULD HAVE BEEN IMPOSED? (Conviction will not necessarily disqualify you for employment - Do not include petty misdemeanors)

YES
NO
process, and that applications must be received by the City Employment Office at Historic City Hall, 915 I Street, Plaza 10. IF “YES” TO NUMBER 10 – PLEASE EXPLAIN:
Level, Sacramento, CA 95814 by 5:00 p.m. on the final filing date specified on the Job Announcement. I hereby
authorize the City to verify the accuracy of the information I have provided on this application. I understand that
applications that do not list related job experience in the “Work Experience” section will be considered incomplete and *11. PREFERENCE POINTS ARE AWARDED TO QUALIFIED VETERANS AND SPOUSES OF DECEASED OR DISABLED VETERANS AND ARE ADDED TO THEIR
EXAM RESULTS. POINTS ARE AWARDED SUBJECT TO THE PROVISIONS OF MINNESOTA STATUTES 43A.11.
will be rejected.
You must supply a copy of your DD214. Disabled veterans must also supply form FL 21-802 or an equivalent letter from a service retirement
board. Spouses applying for preference points must supply their marriage certificate, the veteran’s DD214 and FL 21-802 or death certificate. All
required documentation must be received no later than 4:30 p.m. on the posted closing date.
AUTHORIZATION TO RELEASE EMPLOYMENT RECORDS AND OTHER INFORMATION
I authorize any duly accredited representative of the City of Sacramento to obtain any information relating to my ARE YOU APPLYING FOR VETERAN’S PREFERENCE POINTS?
activities from prior and current employers and others. This information may include, but not limited to, achievement, NO
YES (Veteran who served 181 or more consecutive days and received an honorable discharge)
performance, attendance, personal history, and disciplinary information. I direct prior and current employers to release YES (Veteran who served 181 or more consecutive days and received an honorable discharge and have a service related disability)
such information upon request to the duly accredited representative of the City of Sacramento regardless of any YES (Spouse of a Veteran who served 181 or more consecutive days and received an honorable discharge and has a service related disability)
YES (Spouse of a deceased Veteran who served 181 or more consecutive days and received an honorable discharge and had a service related disability)
agreement I may have had with you previously to the contrary. I release any individual, including records custodians,
from all liability for damages that may result to me on account of compliance or any attempts to comply with this *12. HAVE YOU HAD ANY TRAFFIC RELATED INFRACTIONS IN THE LAST FIVE (5) YEARS? YES NO
authorization. 13. IF YES TO NUMBER 12 – PLEASE EXPLAIN:
I have read and understand the above information.
14. IF YOU NEED SPECIAL ACCOMMODATIONS IN ORDER TO PARTICIPATE IN THE AGENCY HIRING PROCESS, PLEASE EXPLAIN:

Digitally signed by Shannon Brown 3/16/19
Shannon Brown Date: 2019.03.16 12:23:44 -07'00'
X______________________________________ ______________________
SIGNATURE OF APPLICANT DATE