North Whidbey Pool, Park, and Recreation District

Name:*

First NameLast Name

Nickname or other name you are known or have been known by or type n/a:*

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Phone Number:*

Format: (000) 000-0000.

E-mail Address:*

example@example.com

Address: *

Street Address

Street Address Line 2

CityState / Province

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If offered a position with the North Whidbey Pool, Park, and Recreation District, you will be required to furnish proof of your eligibility to work in the U.S.

What job are you applying for?

I am hoping to work?*

Part-time 10-30 hoursFull-Time

If you answered part-time in the question above, how many total hours per week are you hoping to work?*

Write N/A if you are seeking full-time.

If you are seeking part-time work, what is your availability? Please be specific. *

Write N/A if you are seeking full-time.

I am (please choose one)*

at least 15 years of ageat least 18 years of ageat least 21 years age

I cannot work on?

Have your ever applied here before?*

YesNo

If you answered yes, when:*

Write N/A, if not applicable.

Have you ever been convicted of any law violation?*

YesNo

If yes, please give details or type N/A:*

(a conviction will not necessarily disqualify an applicant for employment.)

Have your had your driver's license suspended or revoked in the last three years?*

YesNoN/A

If yes, please give details:*

Write N/A, if not applicable.

If employed, do you expect to be engaged in any additional business or employment outside of our job?*

YesNoN/A

If yes, please give details:*

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How were you referred to us?*

Education

High School Name*

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Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Degree *

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College or University*

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Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Degree/Certificate*

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Vocational or Technical*

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Address*

Street Address

Street Address Line 2

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Postal / Zip Code

Degree/Certificate*

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Job Skills & Training

Describe your skills:*

What skills do you have that are related to the job for which you are applying?

Training or Certifications:*

What additional training do you have that is related to the job for which you are applying?

List professional, trade, business or civic activities and offices held:*

Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability, genetic information or other protected status.

Have your ever been terminated or asked to resign?*

YesNo

If "yes", please explain or type N/A: *

A termination or being asked to resign does not disqualify an applicant for employment.

Employment History

Please list all current and/or previous employment starting with your current or last employer going backward chronologically to your first employer. Include reasons for gaps in employment. If you need more space please list it separately on a sheet of paper and include it as an uploaded document. Please make sure to add the affirmation at the bottom of this application to your additional sheets and sign and date them. Listing "see resume" will disqualify your application from review.

Company:*

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Position:*

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Address*

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Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor:*

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Phone Number:*

Write N/A, if not applicable.Format: (000) 000-0000.

May we contact your previous supervisor for a reference?*

YesNoN/A

Responsibilities:*

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Employment Start and End *

example 06/20/2018-08/24/2020 or write N/A, if not applicable.

Reason for Leaving:*

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Company:*

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Position:*

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Supervisor:*

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Phone Number:*

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May we contact your previous supervisor for a reference?*

YesNoN/A

Responsibilities:*

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Employment Start and End *

example 06/20/2018-08/24/2020 or write N/A, if not applicable.

Reason for Leaving:*

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Company:*

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Position:*

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Address*

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Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor:*

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Phone Number:*

Write N/A, if not applicable.Format: (000) 000-0000.

May we contact your previous supervisor for a reference?*

YesNoN/A

Responsibilities:*

Write N/A, if not applicable.

Employment Start and End *

example 06/20/2018-08/24/2020 or write N/A, if not applicable.

Reason for Leaving:*

Write N/A, if not applicable.

Company:*

Write N/A, if not applicable.

Position:*

Write N/A, if not applicable.

Address:*

Write N/A, if not applicable.

Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor:*

Write N/A, if not applicable.

Phone Number:*

Write N/A, if not applicable.

May we contact your previous supervisor for a reference:*

YesNoN/A

Responsibilities:*

Write N/A, if not applicable.

Employment Start and End *

example 06/20/2018-08/24/2020 or write N/A, if not applicable.

Reason for Leaving:*

Write N/A, if not applicable.

References

Please list three (3) references who are not related to you, but familiar with your work or school life.

Reference 1

Name:*

First NameLast Name

Phone Number*

Format: (000) 000-0000.

Years Known:*

Email*

example@example.com

Reference 2

Name:*

First NameLast Name

Phone Number*

Format: (000) 000-0000.

Years Known:*

Email*

example@example.com

Reference 3

Name*

First NameLast Name

Phone Number*

Format: (000) 000-0000.

Years Known:*

Email*

example@example.com

Additional Employment History:

Upload Cover Letter and Resume:

I agree that my electronic signature below is the legal equivalent of my manual signature. Furthermore, I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. Whether listed or not, I also authorize any person, school, current employer, or organization to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from legal liability in making such statements. I understand I may be required to pass a drug screening examination successfully. I hereby consent to a pre-and/or post-employment drug screen as a condition of employment, if required. I understand that if I am extended an employment offer, it may be conditioned up my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to the work for which I am applying. I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENT BY MANAGEMENT OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN A EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NO GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. O IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRES AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.

Sign and Date:*