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Last Name
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO

For Court Human Resources Use Only

A‰/R‰ SAF ‰
EMPLOYMENT APPLICATION
Mailing Address: Cert.: T ‰ @___/ S ‰ @___
San Diego Superior Court Comments:
Attention: Human Resources
P.O. Box 120128
San Diego, CA 92112-0128
24 HOUR JOB LINE (619) 450-5222 Analyst: Date:

INFORMATION SHEET - Please read carefully before completing application.

Your application and any supplemental information required MUST be received in Human Resources by 5:00 p.m. on the closing date of
the examination. Postmarks, faxes, or late applications will NOT be accepted.
If the position you are applying for has a typing or shorthand requirement, please include appropriate ORIGINAL certificates, issued
within the last two years, which will be returned to you. Incomplete applications will delay the referral process and could be a basis for
disqualification.

First Name
TITLE OF POSITION EXAM NO. -
LAST NAME FIRST NAME
SOCIAL SECURITY NUMBER - -
STREET ADDRESS
CITY STATE ZIP CODE
HOME PHONE ( ) - BUSINESS PHONE ( ) -
WORK LOCATION: Please check those geographic areas in which you are willing to work:
Downtown (San Diego) East County (El Cajon) Kearny Mesa
North County (Vista) South County (Chula Vista)

Do you currently work for or have you worked in the past for either the San Diego Superior Court or any San Diego County
Municipal Court? ................................................................................................................ Yes No
If yes, position title and dates.

Do you currently work for or have you worked in the past for the County of San Diego?............... Yes No
If yes, position title and dates.

Did you graduate from high school or have you received a G.E.D. Certificate?............................. Yes No

Examination Number
EDUCATION: List below your education, beginning with the most recent.

College, University, or Units Did You Graduate? Type of Degree

Course of Study or Major
Vocational School & Location Completed Yes No Earned

TRAINING: List below any training you have completed within the last five years relating to the position for which you are
applying. Attach additional information if necessary.

Name of Agency Providing No. of Classroom

Training Class Subject Dates Attended
the Training Hours

----------------------- Please complete the information requested below. This information will be separated from your application and kept confidential. ---------------------

EMPLOYEE SELF-IDENTIFICATION
The San Diego Superior Court is an equal opportunity employer. To help us maintain current information on our workforce, we ask
that you complete this form. The information will be separated from your application, kept confidential, is completely voluntary, and
will not be used to make any decision about your employment. Select the proper codes from the descriptions below or on the reverse
and insert them in the boxes.

Social Security Number: - - Male = M Female = F

Ethnic code Disability code Sex code

How did you learn about this job? Please check the appropriate box.
Advertisement Internet Website School
Name of paper

Mailing Court Employee Other: ____________________________________

Describe

SDSC ADM-095 (Rev. 7/08) EMPLOYMENT APPLICATION Page 1 of 2

EXPERIENCE: Beginning with your most recent job, list below your relevant employment experience for the past ten years that shows your
qualifications for this position. You are required to provide all of the information requested below. Merely stating "REFER TO RESUME" is
insufficient. Incomplete applications may result in disqualification. If you need more space, please attach additional sheets which include your
name, Social Security Number, the Examination Number and title of the position for which you are applying.

Dates Employer’s Name and Address Official Title:

From: Mo. / Yr. Job Duties:

To: Mo. / Yr.

Hrs. / Week:

Salary: Verify by Contacting:

Name:

Phone: Reason for Leaving:

Dates Employer’s Name and Address Official Title:

From: Mo. / Yr. Job Duties:

To: Mo. / Yr.

Hrs. / Week:

Salary: Verify by Contacting:

Name:

Phone: Reason for Leaving:

Dates Employer’s Name and Address Official Title:

From: Mo. / Yr. Job Duties:

To: Mo. / Yr.

Hrs. / Week:

Salary: Verify by Contacting:

Name:

Phone: Reason for Leaving:

Dates Employer’s Name and Address Official Title:

From: Mo. / Yr. Job Duties:

To: Mo. / Yr.

Hrs. / Week:

Salary: Verify by Contacting:

Name:

Phone: Reason for Leaving:

BILINGUAL: Are you fluent in a language other than English? ............................................................................... Yes No

If yes, in what other language(s) are you fluent?

CONSENT TO RELEASE OF INFORMATION

May we contact your present employer about your character, qualifications and work record?................................ Yes No
NOTE: A NO response to the above question will not affect the review of your qualifications. If you answer no and we need to contact your
present employer before we can offer you a job, you will be contacted first.

I consent to the release of information for use in determining my eligibility, qualifications, and selection consideration about my work record, job
performance, character, ability and fitness by employers, schools, law enforcement agencies and the other individuals and organizations to
authorized employees of the San Diego Superior Court. I hereby release you, your organization, current or previous employers, or others from
liability or damage which may result from furnishing the requested information.

CERTIFICATE OF APPLICANT: I certify that all of the statements in this application are true and complete to the best of my knowledge. I
understand that false statements of material facts or omission of facts regarding my background or relevant employment history may subject me to
disqualification or dismissal.

Date:
Signature (in ink)

ETHNIC CODES DISABILITY CODES

1 BLACK: All persons having origins in any of the original Black racial V VISUAL: Legally blind in one or both eyes or restricted in the visual
groups of Africa. field to 20 degrees.
2 HISPANIC: All persons of Mexican, Puerto Rican, Cuban, Central or H HEARING: Total deafness or inability to hear normal conversation
South American, or other Spanish culture or origin, regardless of race. and/or use a telephone without the aid of an assistance device.
3 ASIAN: All persons having origins in any of the original peoples of the S SPEECH: Speech impairments when speech is unintelligible in normal
Far East, Southeast Asia, Indian subcontinent, for example, conversation.
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the P PHYSICAL: Orthopedic impairments, amputations, or functional
Philippine Islands, Thailand and Vietnam. limitations if there is a significant impairment in one or more
4 AMERICAN INDIAN OR ALASKAN NATIVE: All persons having extremities; or impairment of the trunk, back, spine when there is a
origins in any of the original peoples of North America, and who medically diagnosed disability which substantially limits one or more
maintain cultural affiliation or community recognition major life activities.
5 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER: All persons D DEVELOPMENTAL DISABILITIES: Persons who meet the legal
having origins in any of the original peoples of Hawaii, Guam, Samoa, definition or have been identified as developmentally disabled, include
or other Pacific Islands. autism, cerebral palsy, epilepsy, retardation, and other neurological
6 WHITE (not of Hispanic Origin): All persons having origins in any of impairments.
the original peoples of Europe, North Africa, or the Middle East. M MENTAL: Mental or emotional disorder, including drug addiction and
alcoholism.
N NONE: Not disabled.

SDSC ADM-095 (Rev. 7/08) EMPLOYMENT APPLICATION Page 2 of 2

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