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Application for Employment An Equal Opportunity Employer

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Steps

1. Personal Information This section is complete This section is incomplete
2. Position Information This section is complete This section is incomplete
3. Education This section is complete This section is incomplete
4. Employment History (Please Start With the Most Recent, Ending With Age 18, Excluding Part-Time Positions Held While Obtaining Higher Education—Use Additional Paper as Necessary.) This section is complete This section is incomplete
5. Technology Skills (List All Skills & Software Applications You Have Experience Using) This section is complete This section is incomplete
6. References This section is complete This section is incomplete
7. Step Seven This section is complete This section is incomplete
8. Disclaimer & Signature This section is complete This section is incomplete
9. Veteran’s Preference This section is complete This section is incomplete

Personal Information

First Name*
Last Name*
Other Names Used
Address 1*
Address 2
City*
State*
Zip*
Phone Number*
Email Address*
Webpage Address (es)
Continue

Position Information

Which position are you applying for?*
Type of employment desired*
1. Full Time
2. Part Time
3. Temporary / Seasonal
What shifts will you work?*
1. Days
2. Nights
May We Contact Present Employer?*
1. Yes
2. No
Available Start Date*
Are you eligible to work in the United States? (Federal Law requires proof of identity and employment authorization for all new employees. (Federal Law requires proof of identity and employment authorization for all new employees.)*
1. Yes
1. No
Can you travel if the job requires it?*
1. Yes
2. No
Do you have a valid driver’s license?*
1. Yes
2. No
Continue |Go Back

Education

High School
Location
Dates Attended From / To
Diploma, Degree & Major
Graduated?
College
Location
Dates Attended From / To
Diploma, Degree & Major
Graduated?
Other (Business, Vocational, Military)
Location
Dates Attended From / To
Diploma, Degree & Major
Graduated?
Continue |Go Back

Employment History (Please Start With the Most Recent, Ending With Age 18, Excluding Part-Time Positions Held While Obtaining Higher Education—Use Additional Paper as Necessary.)

Employer
Address
Phone Number
Supervisor
Employed From - To (Date)
Final Rate of Pay
Position
Primary Duties
Reason for Leaving
Employer
Address
Phone Number
Supervisor
Employed From - To (Date)
Final Rate of Pay
Position
Primary Duties
Reason for Leaving
Employer
Address
Phone Number
Supervisor
Employed From - To (Date)
Final Rate of Pay
Position
Primary Duties
Reason for Leaving
Continue |Go Back

Technology Skills (List All Skills & Software Applications You Have Experience Using)

Word Processing
Spreadsheet
Other Software
Database
Microsoft Office
1. Yes
2. No
PowerPoint
1. Yes
2. No
Scanner
1. Yes
2. No
Copier
1. Yes
2. No
Digital Phone Systems
1. Yes
2. No
Explain Internet Skills, Including Email Usage
Professional Licenses or Certificates Held
Military
Are you a veteran or family member who qualifies for and are claiming preference pursuant to Idaho Code § 65-503 or its successor? (If Yes, fill out Page 5 of Application & attach proper documentation)
1. Yes
2. No
Have you previously claimed such preference?
1. Yes
2. No
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References

Please list three professional references.
Full Name*
Address*
Phone Numbers*
Connection To You (i.e. friend, co-worker)*
Occupation*
Full Name*
Address*
Phone Numbers*
Connection To You (i.e. friend, co-worker)*
Occupation*
Full Name*
Address*
Phone Numbers*
Connection To You (i.e. friend, co-worker)*
Occupation*
Continue |Go Back

Step Seven

Have you ever been charged with a crime (other than a minor traffic infraction)?*
1. Yes
1. No
If yes, when and where
Please Explain
Are you related by blood or marriage to any person now employed by Employer?
1. Yes
2. No
If yes, give name and relationship to you
Continue |Go Back

Disclaimer & Signature

I certify that all answers and statements on this application are true and complete to the best of my knowledge. I understand that should an investigation disclose untruthful or misleading answers, my application may be rejected, my name removed from consideration, or my employment may be terminated. I understand and agree that, if hired, my employment is for no definite period and either Employer or I may terminate our relationship at any time, and that this employment application does not constitute an employment contract.
Applicant Signature*
Date
Date
IT IS THE POLICY of ___________________________ to provide equal opportunity in all terms, conditions and privileges of employment for all qualified job applicants and employees without regard to race, color, national origin, gender or age (unless a bona fide job requirement) or the presence of any disability. Reasonable accommodations will be made for disabled persons.
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Veteran’s Preference

Per Idaho Code, Title 65, Chapter 5, Employer will afford a preference to employment of veterans. In the event of equal qualifications and experience between candidates for an available position, a veteran who qualifies will be preferred. If claiming veteran’s preference, please complete the information below and attach a copy of your DD-214 to this application.
If you are not claiming Veteran’s Preference, please enter initials and proceed to the next page.
Initials
(Reference Idaho Code, Title 65, Chapter 5, and 5 U.S.C. § 2108) The term “active duty” means full-time duty in the Armed Forces, but not active duty for training.
Part 1. Preference Eligible Veterans:
1. I served on active duty at any time from December 7, 1941 and ending July 1, 1955.
2. I served on active duty for 180 consecutive days, any part of which occurred after January 31, 1955 and before October 15, 1976.
3. I served on active duty at any time from August 2, 1990 and ending January 2, 1992.
4. I served on active duty for a period of more than 180 consecutive days, any part of which occurred during the period
5. I have a service-connected disability of 10% or more.
6. I am the spouse of an eligible disabled veteran, who has a service-connected disability.
7. I am the widow or widower of an eligible veteran and have remained unmarried.
I served on active duty for a period of more than 180 consecutive days.
1. Yes
2. No
Any part of which occurred during the period beginning on 9-11-01 and ending when prescribed by Presidential proclamation or by law as the last date of Operation Iraqi Freedom.
I have been awarded an Armed Forces Expeditionary Medal (AFEM).
1. Yes
2. No
All AFEM recipients, whether listed here or not, qualify for veteran’s preference and must be shown on your DD-214 form. Examples of some of the most common campaign medals are: Vietnam (Service Medal), El Salvador, Lebanon, Granada, Panama, Bosnia, Kosovo, Afghanistan, Southwest Asia (Persian Gulf), Somalia, and Haiti. (Award of the National Defense Service medal does not qualify.)
For a listing of Wars, Campaigns, and Expeditions of the Armed Forces which qualify for veteran’s preference:
U.S. Office of Visit the Personnel Management Veterans Services page
I do not meet any of the selections above, but I served on active duty in the armed forces of the United States for a period of more than one-hundred eighty days and was honorably discharged.
1. Yes
2. No
By my signature, I certify that all statements on this form are true and complete to the best of my knowledge. I understand that should an investigation disclose inaccurate or misleading answers, my application may be rejected and my name removed from consideration for employment with Employer.
Part 2. Documentation and Signature.
1. I have never received veteran’s preference by any State of Idaho agency. (If you have received an initial appointment claiming veteran’s preference, you are not eligible for preference.)
2. I have attached a copy of my DD-214. Veteran’s preference will not be considered without this document.
Electronic Signature
By typing your signature, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Date
Date
Authorization for Release of Personal Information
View the Authorization for Release of Personal Information (PDF).

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Weiser, ID 83672
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