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

OTHER SKILLS
SKILL SKILL LEVEL EXPERIENCE (YEARS OR MONTHS)
4 SKILLED
Microsoft Office Suite 0 BEGINNER 0 EXPERT 25 Years
SKILL SKILL LEVEL EXPERIENCE (YEARS OR MONTHS)
0
0
o BEGINNER SKILLED EXPERT
SKILL SKILL LEVEL EXPERIENCE (YEARS OR MONTHS)
o BEGINNER 0
0 SKILLED EXPERT
LANGUAGES OTHER THAN ENGLISH THAT YOU ARE PROFICIENT IN
LANGUAGE LANGUAGE
0
DWRITE
0 READ
0 SPEAK DWRITE 0 SPEAK READ
ADDITIONAL INFORMATION
Clinical Experience, Honors & Awards, Interests & Activities, Military Service, Personal, Professional Associations, Professional Memberships, Publications,
Technical, Volunteer Experience, Other/Miscellaneous
Member, American Public Works Association
Member, Floodplain Management Association
Member, Assn. of State Floodplain Managers

REFERENCES
Name, title, phone number, email, and mailing address.
Please list references you wish to include (Personal/Professional). Please include
- Kris Balaji, PE; Director of Public Works;County of San Joaquin; (209)468-3100; kbalajisjgov.org ; 1810 E. Hazelton Ave.
Stockton CA 95205
- Mike Kashiwagi, PE; Chief Operating Officer; Interwest Consulting Group; (916)683-3340; mkashiwagi@interwestgrp.com ;
9300W. Stockton Blvd. Ste. 105, Elk Grove, CA 95758
- Richard Shepard, FE; Public Works Director/City Engineer (retired); City of Elk Grove; richshepardyahoo.com
- Jerry Way; Director of Public Works (retired); City of Sacramento; jway©cityofsacramento.org
- Darren Wilson, FE; Director of Development Services; City of Elk Grove; (916) 627-3446; dwilson©elkgrovecity.org ; 8401
Laguna Palms Way, Elk Grove, CA 95758

APPLICANT DECLARATIONS

I certify that all statements in this application are true and complete. I agree and understand that any misstatements or
omissions of material facts herein will cause forfeiture on my part of all rights to employment by the City of
Sacramento. I understand that if I do not meet the announced requirements, I will be eliminated from the examination
process, and that applications must be received by the City Employment Office at Historic City Hall, 915 I Street, Plaza
Level, Sacramento, CA 95814 by 5:00 p.m. on the final filing date specified on the Job Announcement. I hereby
I understand that
authorize the City to verify the accuracy of the information I have provided on this application.
applications that do not list related job experience in the "Work Experience" section Will be considered incomplete and
will be rejected.

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
activities from prior and current employers and others. This information may include, but not limited to, achievement,
I direct prior and current employers to release
performance, attendance, personal history, and disciplinary information.
such information upon request to the duly accredited representative of the City of Sacramento regardless of any
I release any individual, including records custodians,
agreement I may have had with you previously to the contrary.
from all liability for damages that may result to me on account of compliance or any attempts to comply with this
authorization.
I have read and understand the above information.

W DATE

NATOF APPLICANT