POSITION

PERSONAL INFORMATION

EDUCATION

List any colleges, military, trade, business, or other schools attended.

CERTIFICATES & LICENSES

List professional license, registration, or certificate required or preferred for position.

EMPLOYMENT HISTORY

The information in this section will be used to determine if you meet the minimum qualifications as outlined in the job announcement. Clearly describe all your duties, starting with your most recent job. Resumes will be accepted only if required on the job announcement and will not be accepted in place of a completed application. If you need additional space, use the box at the bottom of this section.

REFERENCES

CERTIFICATION & SIGNATURE

I hereby certify that all statements made in this application are true, and I agree and understand that any statement that is false, fraudulent, or misleading in this application or attached material, during the interview or screening process, or discovered during any employment-related process (post hire) may result in the revoking of a job offer or termination of employment. Typing my name on the signature line qualifies as my acknowledgement and signature.

• I certify that all statements contained herein are true and complete.

• I understand that I must provide proof I am authorized to work in the United States, in accordance with federal law, if I am hired.

• I authorize the employing agency to verify the employment and education information provided in this employment application. • I authorize my driving record to be checked if the position for which I am applying requires driving. • I understand and agree to be subjected to a pre-employment drug screening and criminal history background check, if applicable.

• I understand that I must provide proof I am authorized to work in the United States, in accordance with federal law, if I am hired.

• I authorize the employing agency to verify the employment and education information provided in this employment application.

• I authorize my driving record to be checked if the position for which I am applying requires driving.

• I understand and agree to be subjected to a pre-employment drug screening and criminal history background check, if applicable.

Veterans’ Preference Form (ORS 408.230)

Veterans who meet the minimum qualifications for a position open for recruitment may be eligible for preference in employment under Oregon law. If you are a Qualified Veteran or Qualified Disabled Veteran and would like to be granted preference in the selection and hiring process for a specific posted job, please fill out this Veterans’ Preference Form and provide proof of eligibility by submitting a copy of form DD-214 or 215 (copy 4). This completed form and required supporting documentation must be submitted with your application for consideration for Veterans’ Preference.

Qualified Veteran Questions: Veterans’ preference may be claimed if you check at least one of the boxes below and provide proof via form DD-214 or 215 (Copy 4) ORS 408.225(f) – I served on active duty with the Armed Forces of the United States:

Qualified Disabled Veteran Questions: Additional preference may be claimed if you check at least one box below and provide proof of eligibility via a copy of DD214 or 15, Copy 4, and a public employment preference letter from the United States Department of Veteran’s Affairs (letter may be requested by calling 800-827-1000)

I hereby claim Veterans’ Preference, have attached proof of eligibility as directed and certify that the above information is true and correct. I understand that any false statements may be cause for my disqualification, or dismissal, regardless of when discovered.