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Job Application Form
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Step
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EPIC is committed to the principle of equal employment opportunity. It is EPIC’s policy to not discriminate and/or deny services against any person on the basis of sex, gender identity, race, ethnicity, color, religion, age, national origin, citizenship, ancestry, physical or mental disability, family configuration, sexual orientation, gender expression, culture or public assistance recipient status. This applies to prospective as well as current employees, parents, children and guardians that apply for and receive services.
POSITION YOU ARE APPLYING FOR AND LOCATION(S):
Job Title
*
Today's Date
*
Please list location(s) you are applying for
*
APPLICANT INFORMATION
Name
*
First
Middle
Last
Mailing Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Email Address
*
Are you a citizen of the United States?
*
Yes
No
If not, are you authorized to work in the U.S?
Yes
No
Have you ever worked for EPIC?
*
Yes
No
When did you work for EPIC?
Are you a current or former Head Start or ECEAP Parent?
*
Yes
No
When?
Have you ever been convicted of any crime or is there a criminal charge pending against you?
*
Yes
No
Please explain
Have you ever been convicted of a felony?
*
Yes
No
Please explain
Do you own your own motor vehicle & State required insurance?
*
Yes
No
Do you have other means of transportation?
Yes
No
Why are you interested in this particular job?
*
What skills & training qualify you for this position?
*
What portion of your work experience qualifies you for this position?
*
List any foreign language you can speak, read, and or write.
If position requires bilingual ability, EPIC will administer an examination determining the level of Spanish.
Next
EDUCATION
Name of High School
*
High School Address
*
City/State
From - To
*
Timeline
Did you graduate?
*
Yes
No
Degree
*
Name of College
*
College Address
*
City/State
From - To
*
Timeline
Did you graduate?
*
Yes
No
Degree
*
Graduate Studies
*
Address
*
City/State
REFERENCES
Please list three work-related professional references (include phone number and email address)
*
PREVIOUS EMPLOYMENT #1
Company
*
Address
*
Phone
*
Job Title
*
Responsibilities
*
Supervisor
*
From - To
*
Timeline
Reason for Leaving
*
May we contact your previous supervisor for a reference?
*
Yes
No
PREVIOUS EMPLOYMENT #2
Company
*
Address
*
Phone
*
Job Title
*
Responsibilities
*
Supervisor
*
From - To
*
Timeline
Reason for Leaving
*
May we contact your previous supervisor for a reference?
*
Yes
No
MILITARY SERVICE
Branch
From - To
TImeline
Rank at Discharge
Disclaimer Statement:
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release from employment. All applicants offered employment must have a Cleared Portable background check through the Department of Children, Youth & Families (DCYF) and/or fingerprinting check/WA State Patrol criminal background check, when required.
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