1840 SE 8th Ave, Camas WA
98607
(360) 833-2076 Phone (360) 834-5397 Fax
Application for Employment
- Fill it out and mail, fax, e-mail or bring it in
We are an equal opportunity employer and do not unlawfully
discriminate in employment. No question on this application is used
for the purpose of limiting or excluding any applicant from
consideration for employment on a basis prohibited by local, state,
or federal law. Equal access to employment, services, and programs is
available to all persons. Those applicants requiring reasonable
accommodation to the application and/or interview process should
notify a representative of the organization.
Applicant name:
Date:
Position(s) applied for or type of work
desired:
Address:
Telephone #:
Social Security #:
Type of employment desired:
full-time
part-time
temporary
Date you will be available to start work:
Are you able to meet the attendance
requirements?
Yes
No
Do you have any objection to working overtime
if necessary?
Yes
No
Can you travel if required by this position?
Yes
No
Have you ever been previously employed by our
organization?
Yes
No
Can you submit proof of legal employment
authorization and identity?
Yes
No
If you are under 18, can you furnish a work
permit if it is required?
Yes
No
Have you ever been convicted of a crime in
the last 7 years?
Yes
No
If yes, please explain (a conviction will not
automatically bar employment):
Valid State issued Drivers license number:
Can you provide a current driving state
record for insurance purposes? ______________
How were you referred to us?
Can you supply personal hand tools?
______________
Employment
History
Please provide all employment information for
your past four employers starting with the most recent.
Employer:
Position held:
Address:
Telephone #:
Immediate supervisor and title:
Dates employed: from
to
Salary:
Job summary:
Reason for leaving:
Employer:
Position held:
Address:
Telephone #:
Immediate supervisor and title:
Dates employed: from
to
Salary:
Job summary:
Reason for leaving:
Employer:
Position held:
Address:
Telephone #:
Immediate supervisor and title:
Dates employed: from
to
Salary:
Job summary:
Reason for leaving:
Employer:
Position held:
Address:
Telephone #:
Immediate supervisor and title:
Dates employed: from
to
Salary:
Job summary:
Reason for leaving:
Other
Skills and Qualifications
Summarize any job-related training, skills,
licenses, certificates, and/or other qualifications:
Educational
History
List school name and location, years
completed, course of study, and any degrees earned:
High school:
College:
Technical Training:
Other:
References
List 3 references names, telephone numbers,
and years known (do not include relatives or employers):
_____________________________________________________________________________________
I hereby authorize the potential employer to contact, obtain,
and verify the accuracy of information contained in this application
from all previous employers, educational institutions, and
references. I also hereby release from liability the potential
employer and its representatives for seeking, gathering, and using
such information to make employment decisions and all other persons
or organizations for providing such information.
I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.
If I am employed, I acknowledge that there is no specified
length of employment and that this application does not constitute an
agreement or contract for employment. Accordingly, either the
employer or I can terminate the relationship at will, with or without
cause, at any time, so long as there is no violation of applicable
federal or state law.
I understand that it is the policy of this organization not to
refuse to hire or otherwise discriminate against a qualified
individual with a disability because of that persons need for a
reasonable accommodation as required by the ADA.
I also understand that if I am employed, I will be required to
provide satisfactory proof of identity and legal work authorization
within three days of being hired. Failure to submit such proof within
the required time shall result in immediate termination of
employment.
I represent and warrant that I have read and fully understand
the foregoing, and that I seek employment under these conditions.
Applicant signature:
Date: