Employment Application

Position Applied For(Required)

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Work Phone

Email(Required)

Best time to contact you:(Required)

:

Have you ever been employed by Community Action of Skagit County (or Skagit County Community Action Agency)?(Required)

Yes

No

Approximate Dates:(Required)

Are you known to schools/other organizations by a different name?(Required)

Yes

No

Other Name(Required)

Do you have relatives employed by Community Action of Skagit County, or serving on its Board of Directors?(Required)

Yes

No

A yes answer will not necessarily exclude an applicant but will be used to prevent placement which may create a conflict of interest.

Please list the name and relationship(Required)

Are you legally authorized to work in the U.S.?(Required)

Yes

No

Documentation proving eligibility must be provided within 3 days of hire as required by law.

Are you at least 18 years of age?(Required)

Yes

No

Check those that you are able to work:(Required)

Full-Time

Part-Time

Evenings

Weekends

Are you currently employed?(Required)

Yes

No

Date available to begin working with Community Action:(Required)

Are you on lay-off status or subject to recall elsewhere?(Required)

Yes

No

Please explain:(Required)

Have you ever been involuntarily terminated from a job or asked to resign?(Required)

Yes

No

Please explain:(Required)

Are you willing to travel as part of your job duties?(Required)

Yes

No

Do you possess a valid Washington State driver's license?(Required)

Yes

No

Are you able to perform, on a regular basis, the essential duties of the position for which you are applying, with or without reasonable accommodation?(Required)

Yes

No

Employment History

Employer

Supervisor

Email Address

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Date of Hire

Date of Separation

Reason for Leaving

General Position Overview

May we contact?

Yes

No

Employer

Supervisor

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Date of Hire

Date of Separation

Reason for Leaving

General Position Overview

May we contact?

Yes

No

Employer

Supervisor

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Date of Hire

Date of Separation

Reason for Leaving

General Position Overview

May we contact?

Yes

No

Education

Education(Required)

School

Location (City, State)

Degree/ Certificate

Please list your education, beginning with High School.

Other Education

School

Location (City, State)

Degree/ Certificate

Other Education

School

Location (City, State)

Degree/ Certificate

Training

Please list any relevant specialized training, apprenticeship, skills (office equipment, software programs, etc.)

Licenses/ Certificates

Please list any licenses or certificates you hold which are necessary or useful in this position. List kind of license/certification, issuing state, expiration date.

Professional / Business Activities

Please list any professional, trade, business, or civic activities and offices held. You may exclude memberships that would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status.

Additional Information

Please state any additional information you feel may be helpful to us in considering your application.

Work Reference #1(Required)

Name

Title

Business

Phone

Email Address

Work-related reference who may be contacted - preferably recent employers.

Work Reference #2(Required)

Name

Title

Business

Phone

Email Address

Work-related reference who may be contacted - preferably recent employers.

Work Reference #3(Required)

Name

Title

Business

Phone

Email Address

Work-related reference who may be contacted - preferably recent employers.

U.S. Military Service

Branch of Service

Service Dates

Military Specialty

Unemployment

Please list periods of unemployment of 90 days or more and explain.

How did you learn about this position?

Please specify(Required)

Authorization & Certification(Required)

I agree to the statements below

I certify that the information given by me to Community Action of Skagit County is true and complete to the best of my knowledge. I understand that if I am employed, discovery that I gave false information or omitted information during the application process may result in immediate dismissal.

I authorize Community Action of Skagit County to solicit information regarding my education and previous employment, and to contact any and all references I have given on my application. I hereby release all parties and persons connected with any such request for information from all claims, liabilities, and damages for any reason arising out of the furnishing of such information. If employed, I release Community Action of Skagit County from any liability for future references it may provide regarding my work history with Community Action of Skagit County.

I further certify that I am not engaged in any outside activity or business that could be considered in conflict with Community Action's interests or those of its clients, nor will I become engaged in such activity or business if employed.

I understand and acknowledge that any employment relationship with Community Action of Skagit County is of an at-will nature. This means that my employment and compensation can be terminated with or without cause, and with or without notice at any time, at the option of either Community Action of Skagit County or myself. I understand that no representative of Community Action, other than the Executive Director, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

Pursuant to RCW 43.43, all applicants and new or current employees who will or may have unsupervised access to children under 16 years of age, developmentally disabled persons or vulnerable adults, shall be required to undergo a criminal background check. Individuals who have resided in Washington State for less than three years must be fingerprinted as part of this process. Employees required to undergo a background check are employed on a conditional basis pending the results of the investigations.

If employed, I understand and agree that all company property must be returned in good condition and any indebtedness to Community Action of Skagit County must be paid as soon as possible. Further, I understand and agree that if I lose, damage, or fail to return any Community Action property, or if I fail to repay Community Action for any indebtedness in a timely manner, Community Action of Skagit County is authorized to deduct from my wages sufficient funds to satisfy any unpaid obligation.

Resume Upload(Required)

Max. file size: 32 MB.

To be considered for this position, please attach your resume to this application.

Letter of Interest Upload(Required)

Max. file size: 32 MB.

To be considered for this position, please attach your cover letter to this application.