Apply for an Employment Opportunity Fill out the application below and we'll be in touch! Step 1 of 5 20% Personal InformationName* First Middle Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Work Phone*Cell Number*Best Time To Contact YouEmail Address* Social Security Number (Voluntary):For Current Woodland Center Employees - Department Where You WorkAre you legally eligible for employment in this country?*YesNo(If yes, verification will be required.)Are you 18 years of age or older?*YesNoPosition applying for:*Date available to work?*What is your minimum salary requirement?*Employment Conditions: Check as many as you are willing to work.* Regular, full-time Regular, part-time Temporary, full-time Temporary, part-time Can you travel if the job requires it?*YesNoAre you currently on "lay off" status and subject to recall?*YesNo EducationHigh School*Name and Address of InstitutionCourse of Study Major/MinorCircle Last Year CompletedDid you Graduate?Diploma / Degree College*Name and Address of InstitutionCourse of Study Major/MinorCircle Last Year CompletedDid you Graduate?Diploma / Degree Other (Specify)Name and Address of InstitutionCourse of Study Major/MinorCircle Last Year CompletedDid you Graduate?Diploma / Degree Other (Specify)Name and Address of InstitutionCourse of Study Major/MinorCircle Last Year CompletedDid you Graduate?Diploma / Degree Work Related Licensure (Check appropriate)* LICSW LP MD RN LMFT LPN None Licensed Professionals: Have you ever been reprimanded, censured, or otherwise disciplined by, or have you been subject to a corrective action/plan by an licencing board, peer review organization, third party payer, clinic, hospital, medial staff, or any health-related agency or organization?YesNoIf yes, explain: Employment ExperienceList present and past employers beginning with your most recent positionDate Employed From/To*Employer*Employer Phone Number*Employer Address*May we contact this employer?*YesNoIf no, please explain:Wage for this position:**Full-TimePart-TimeSummarize the nature of work performed and job responsibilities:*Reason for Leaving*Employer 2Date Employed From/To*Employer*Employer Phone Number*Employer Address*May we contact this employer?*YesNoIf no, please explain:Wage for this position:**Full-TimePart-TimeSummarize the nature of work performed and job responsibilities:*Reason for Leaving*Employer 3Date Employed From/ToEmployerEmployer Phone NumberEmployer AddressMay we contact this employer?YesNoIf no, please explain:Full-TimePart-TimeSummarize the nature of work performed and job responsibilities:Reason for Leaving ReferencesList people who know you well, preferably from a work environment. Do not refer to an acquaintance or relative.*NameRelationship/TitleAddressPhone References #2*NameRelationship/TitleAddressPhone References #3NameRelationship/TitleAddressPhone Signature of ApplicantIt is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. I give the employer the right to investigate all references and to secure additional information about me, if job-related. I hereby release from liability the employer and its representatives from seeking such information and all other persons, corporations or organizations for furnishing such information. The employer is an Equal Opportunity Employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law. This application is current for 3 months. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application. I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary. I understand it is this county's policy not to refuse to hire a qualified individual with a disability because of this person's need for an accommodation that would be required by the ADA.Your SignatureDate* Date Format: MM slash DD slash YYYY CAPTCHA
