APPLICATION FOR EMPLOYMENT
CITY OF FORTUNA 621 Eleventh Street • P.O.Box 545 Fortuna, CA 95540 • Phone (707) 725-7600 Fax (707) 725-7610
The City of Fortuna considers applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
Upon request, applications may be made available in alternative accessible formats, as is assistance in completing the application. If you need special assistance in order to participate in the testing and interview process, please advise the Personnel Office at least 48 hours prior to your appointment so that the City may make reasonable arrangements to assure accessibility.
(PLEASE PRINT)
Position Applied For: Date:
Planning Commissioner 12/28/2022
PERSONAL INFORMATION
Last Name First Name Middle Name
Dorris Joshua Zeke
Address City State/Zip
Fortuna CA 95540
Mailing Address (if different) City State/Zip
Telephone Number(s) E-mail Address
If you are under 18 years of age, can you provide proof of your eligibility to work? Yes wo Have you ever filed an application with the City of Fortuna before? Give date:
Have you ever been employed with the City of Fortuna before? Give date:
Are you currently employed?
May we contact your present employer?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.
Jan. 2023
On what date would you be available for work? Give date:
Are you available to work: Full Time V Part Time _Shift work Temporary Are you currently on "lay-off" status and subject to recall? Can you travel if a job requires it? YesN
2018
EMPLOYMENT EXPERIENCE
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender; national origin, disabilities or other protected status. Do not substitute this section with resume Employer
County of Humboldt Dates Employed: From: 02/2017 To: present Address Work Performed:
Provide lead direction, training and work review of planners, coordinate Telenhone Number(s)
Job Title / Supervisor Presentin to plating omision and 3o0s, ire awes policie, Senior Planner/ Bob Russell
Reason for Leaving
rocedures, regulations, maps, site/building plans, exercise sounc NA ndependent judgement within established guideline:
Employer
County of Lake Dates Employed: From: 02/2016 To: 02/2017 Address Work Performed:
Perform range of professional planning duties, receive/process appli- Telephone Numbers)
Job Title / Supervisor
Associate Planner/Michalyn Delvalle
Reason for Leaving tions related to processing of land use development applications.
Relocated to Humboldt
Employer
ENPLAN Dates Employed: From: 06/2013 To: 02/2016
Address Work Performed:
Create, deliver and maintain GIS datasets, develop and maintain web Telephone Number(s) mapping applications, update datasets for municipal clients web GIS programs, establish processes to ensure and maintain data integrity, Job Title / Supervisor epare response to proposals to bid on jobs, trained and reviewed new GIS Analyst/Randy Hauser mployees' work performance
Reason for Leaving
Was contract job, secured full-time employment
Employer
Montana State Library Dates Employed: From: 02/2008 To: 05/2013 Address Work Performed:
Manage State of Montana Transportation Framework Theme GIS Telephone Number(s)
Job Title / Supervisor
GIS Analyst/Stu Kirkpatrick presidence presentions trista meting a doles, Reason for Leaving
Relocated to CA road out i strati ocal state eat and ra and overkshops, If you need additional space, please continue on a separate sheet of paper. 2018
EDUCATION
Name & Address of School Course of Study Years Completed Diploma/Degree Alps View general education 4 HS Diploma
High School Weaverville, CA
Nest Valley College general education 3
Indergraduate College Saratoga, Cl
Humboldt State Universit BS
Graduate Professional Arcata, CA 4
Other (specify)
Describe any specialized training including military training, apprenticeship, skills and job-related extra-curricular activities.
REFERENCES
(1) Name Phone Number
Justin Garwood
Address
Arcata, CA
(2) Name Phone Number
Bob Russell
Address
Eureka, CA
13) Name Phone Number
Jocelyn Godinho
Address
APPLICANT'S STATEMENT
I certify that the answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
I understand that a credit or consumer report may be part of this investigation. / further understand that / have the right to make a written request, within a reasonable time, for a complete and accurate disclosure of information about the nature and scope of such investigation.
I understand that as a condition of employment / may be required prior to and during employment to take and pass medical and psychological tests including drug and alcohol screenings.
In the event of employment, / understand that false or misleading information given in my application or interview may result in discharge.
I understand that, if hired, / will be required to abide by all rules and regulations of the City of Fortuna. goshna Doris 12/28/22
Signature of Applicant Date
2018