Security Information For Participants - California Department Of Public Health - Public Health Microbiologist I Open Examination Continuous Testing Page 5
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5CONDITIONS OF EMPLOYMENT (631)
Examination Title: Public Health Microbiologist I
Name: _____________________________
(Print: first, middle initial, last)
FFD:
Continuous
If you are successful in your examination your name will be placed on the active employment list and certified to fill
vacancies according to the conditions you specify on this form. If you are unwilling to accept work or do not reply
promptly to communications your name will be placed on the inactive list.
Locations in which you are willing to work:
Please check your choices - you will not be offered a job in locations not checked.
Contra Costa County (0700) _____
TYPE OF EMPLOYMENT DESIRED:
,
:
ON A PERMANENT BASIS
I AM WILLING TO WORK
_____ Full Time
_____ Part Time (regular hours less than 40)
_____ Intermittent (on call)
_____ Limited Term
,
:
ON A TEMPORARY BASIS
I AM WILLING TO WORK
_____ Full Time
_____ Part Time (regular hours less than 40)
_____ Intermittent (on call)
_____ Limited Term
It is your responsibility to notify the Department of Public Health, Examination Services Unit, of any changes in your
address or availability for employment. All correspondence must include your examination title, identification number and
Social Security number.
Signature: __________________________________
Date: __________________________
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