Fillable EMPLOYMENT APPLICATION (Columbia Gorge Community College)

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EMPLOYMENT APPLICATION (Columbia Gorge Community College)

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HUMAN RESOURCES
Mailing Address: 535 NE 5
th
Street
McMinnville, Oregon 97128
p. 503-474-4901 f. 503-434-7553
www.co.yamhill.or.us
EMPLOYMENT APPLICATION
Thank you for taking the time to complete this application. Yamhill County attempts to select
candidates who most closely match the needs of the specific position being advertised.
Applicants selected for interview will generally be contacted within 10 working days of the closing
date of the recruitment. Due to the large number of applications the County receives, it is not
practical for department managers to contact applicants unless they are selected for an interview.
Recruitments which list “closed when filled” will be discontinued without further notice as soon as
a satisfactory candidate match is found. You may check the County's website at
https://www.co.yamhill.or.us/content/employment-listings for a list of current vacancies.
About the application itself: Please complete the application in its entirety. Due to COVID
restrictions, in-person delivery of your application is not an option at this time. You may
deliver the application to the drop box inside the entrance to the Yamhill County courthouse at
535 NE 5
th
Street, McMinnville, email it to employment@co.yamhill.or.us, mail it to the address
above, or fax it to (503) 434-7553. If you fax, please call Human Resources to be certain it has
been received. Be sure you use your actual mailing address (i.e., post office box). You are
welcome to attach a resume, copies of letters of reference, copies of transcripts, certificates, or
samples of work. Please do not attach originals; they will not be returned. Documents you attach
will not be considered as a substitute for the information requested on the application - please do
not respond to a question with the statement “see résumé”. If a question does not apply, write
“n/a” for “not applicable”.
Under the provisions of the Immigration Reform and Control Act of 1986, any person hired or
rehired is required to provide evidence of identity and eligibility for employment. The County
verifies the valid work authorization of each employee using Form I-9 and the E-Verify Program.
Yamhill County is an equal opportunity employer and does not discriminate on the basis of race,
color, religion, sex, national origin, age, marital status, disability, or any other category /status
protected by law. Please do not include information or photos that would identify those
personal traits.
In compliance with the Americans with Disabilities Act, the County will provide reasonable
accommodation for assistance in the application process upon request made to the personnel
office.
Under Oregon law ORS 408.225-408.238, veterans who meet the minimum qualifications for a
position may be eligible for hiring preference. If you think you may qualify, there is Veteran’s
Hiring Preference Form that must be completed and submitted with application. The form and
instructions for the additional documentation that must be submitted can be found on the Yamhill
County Jobs page
(https://www.co.yamhill.or.us/sites/default/files/Veterans%20Hiring%20Preference%20Form.pdf)
or by calling 503-474-4901.
Some positions require a criminal history check and a review of driving record. All County
positions require regular, prompt, and consistent attendance.
Health & Human Services applicants please read the following: ORS 443.004 is now in effect for
individuals hired or subject to a background check after July 28, 2009. This law directly impacts
the background check process and prohibits the use of public funds to support employment of
individuals convicted of specific crimes. A list of covered crimes is posted on the County website
or available upon request by calling Human Resources at the number listed at the top of this
page.
EMPLOYMENT APPLICATION
QUESTIONS WITH AN * REQUIRE A RESPONSE. YOUR APPLICATION MAY NOT BE
CONSIDERED IF INCOMPLETE.
JOB INFORMATION
* Job Number:
* POSITION TITLE:
* FIRST NAME
MI
* LAST NAME
* ADDRESS
* CITY
* STATE
* ZIP
* HOME PHONE
ALTERNATE PHONE
* EMAIL ADDRESS
* OTHER NAMES USED DURING EMPLOYMENT:
EDUCATION
WHAT IS YOUR HIGHEST LEVEL OF EDUCATION:
Some High School Some College Associate’s Degree Master’s Degree
High School Technical College Bachelor’s Degree Doctorate
HIGH SCHOOL EDUCATION
DID YOU GRADUATE FROM HIGH SCHOOL OR RECEIVE A G.E.D.? YES NO
IF NO, WHAT WAS THE HIGHEST LEVEL COMPLETED? 7 8 9 10 11 12
SCHOOL NAME
CIT
Y
STATE
COLLEGE/UNIVERSITY EDUCATION
SCHOOL NAME
DEGREE RECEIVED
SCHOOL LOCATION (CITY/STATE)
DID YOU GRADUATE?
YES
NO
SEMESTER QUARTE
R
# OF UNITS COMPLETED:
MAJO
R
SCHOOL NAME
DEGREE RECEIVED
SCHOOL LOCATION (CITY/STATE)
DID YOU GRADUATE?
YES
NO
SEMESTER QUARTE
R
# OF UNITS COMPLETED:
MAJO
R
SCHOOL NAME
DEGREE RECEIVED
SCHOOL LOCATION (CITY/STATE)
DID YOU GRADUATE?
YES
NO
SEMESTER QUARTE
R
# OF UNITS COMPLETED:
MAJO
R
DRIVER’S LICENSE INFORMATION
* IF THE POSITION INVOLVES DRIVING, DO YOU HAVE A VALID LICENSE?
YES
NO
STATE WHERE ISSUED
CLASS
CERTIFICATES & LICENSES
TYPE:
ISSUED (MONTH/YEAR):
EXPIRATION DATE (MONTH/YEAR):
LICENSE NUMBER:
ISSUING AGENCY:
TYPE:
ISSUED (MONTH/YEAR):
EXPIRATION DATE (MONTH/YEAR):
LICENSE NUMBER:
ISSUING AGENCY:
TYPE:
ISSUED (MONTH/YEAR):
EXPIRATION DATE (MONTH/YEAR):
LICENSE NUMBER:
ISSUING AGENCY:
WORK HISTORY
List your work experience, paid or unpaid, beginning with your present or most recent job. List the past ten years of employment
history, if you have worked that long and describe each job separately, emphasizing your specific tasks and any supervisory, technical,
or other responsibilities. Give special attention to experience that relates to the job for which you are applying. Be as complete as you
can in order to provide the best picture of your skills and experience. If more space is needed for “duties”, you may attach additional
sheets.
DATES
From:
To:
EMPLOYER
POSITION TITLE
ADDRESS
CITY
STATE
PHONE NUMBER
SUPERVISOR (NAME & TITLE)
HOURS WORKED PER WEEK
MAY WE CONTACT THIS EMPLOYER?
YES
NO
DUTIES
REASON FOR LEAVING
DATES
From:
To:
EMPLOYER
POSITION TITLE
ADDRESS
CITY
STATE
PHONE NUMBER
SUPERVISOR (NAME & TITLE)
HOURS WORKED PER WEEK
MAY WE CONTACT THIS EMPLOYER?
YES
NO
DUTIES
REASON FOR LEAVING
DATES
From:
To:
EMPLOYER
POSITION TITLE
ADDRESS
CITY
STATE
PHONE NUMBER
SUPERVISOR (NAME & TITLE)
HOURS WORKED PER WEEK
MAY WE CONTACT THIS EMPLOYER?
YES
NO
DUTIES
REASON FOR LEAVING
DATES
From:
To:
EMPLOYER
POSITION TITLE
ADDRESS
CITY
STATE
PHONE NUMBER
SUPERVISOR (NAME & TITLE)
HOURS WORKED PER WEEK
MAY WE CONTACT THIS EMPLOYER?
YES
NO
DUTIES
REASON FOR LEAVING
SKILLS
OFFICE SKILLS
TYPING (NET WORDS PER MINUTE)
DATA ENTRY (NET WORDS PER MINUTE)
COMPUTER HARDWARE USED:
COMPUTER SOFTWARE USED:
OTHER SKILLS
SKILL
SKILL LEVEL
BEGINNER SKILLED EXPERT
EXPERIENCE (YEARS OR MONTHS)
SKILL
SKILL LEVEL
BEGINNER SKILLED EXPERT
EXPERIENCE (YEARS OR MONTHS)
SKILL
SKILL LEVEL
BEGINNER SKILLED EXPERT
EXPERIENCE (YEARS OR MONTHS)
LANGUAGES OTHER THAN ENGLISH THAT YOU ARE PROFICIENT IN
LANGUAGE
SPEAK READ WRITE
LANGUAGE
SPEAK READ WRITE
ADDITIONAL INFORMATION
Clinical Experience, Honors & Awards, Interests & Activities, Military Service, Personal, Professional Associations, Professional Memberships, Publications,
Technical, Volunteer Experience, Trainings, Other/Miscellaneous
ATTACHMENTS
Please list any attachments you are including with your application.
SUPPLEMENTAL QUESTIONS
The purpose of the following questions is to provide us with statistics needed to evaluate our recruitment program
as well as to prepare statistical reports required by Federal, State and local agencies. The information obtained
also includes additional job related information, such as your preference of work hours and locations, to better
evaluate you for the position for which you are applying.
QUESTIONS WITH AN * REQUIRE A RESPONSE. YOUR APPLICATION MAY NOT BE CONSIDERED IF INCOMPLETE.
*1. DATE YOU ARE AVAILABLE TO START: _________________
*2. DESIRED WAGE: _______________
*3. PLEASE INDICATE WHICH HOURS YOU ARE WILLING TO WORK: (CHECK ALL THAT APPLY)
EMPLOYMENT:
FULL TIME PART TIME TEMPORARY FULL TIME
TEMPORARY PART TIME ON CALL VOLUNTEER
INTERNSHIP
SHIFTS:
DAYS SWING GRAVEYARD
WEEKENDS ON CALL
IF YOU MARKED THAT YOU ARE NOT AVAILABLE FOR ALL HOURS OR DAYS, YOU ARE WELCOME TO PROVIDE AN EXPLANATION.
*4. HOW DID YOU LEARN ABOUT OUR JOB OPENING? (PLEASE CHECK ALL THAT APPLY, IF RESOURCE NOT LISTED,
PLEASE MARK ‘OTHER’ AND PROVIDE THE SPECIFIC NAME OF THE PUBLICATION, WEBSITE, OR RESOURCE)
CAREERBUILDER.COM
CRAIGSLIST.COM
YAMHILL COUNTY WEBSITE
OREGON EMPLOYMENT DEPARTMENT
OREGONIAN NEWSPAPER
OREGONIAN ON-LINE
STATEMAN JOURNAL NEWSPAPER
NEWS REGISTER
NEWBERG GRAPHIC
“IN-HOUSE” ANNOUNCEMENT
OTHER ______________________________
*5. HAVE YOU PREVIOUSLY WORKED FOR YAMHILL COUNTY?
YES
NO
IF ‘YES’, PLEASE PROVIDE LAST POSITION HELD AND DATES OF EMPLOYMENT:
POSITION: ______________________________________ DATES: ______________________________
*6. REFERENCES: LIST THREE WORK REFERENCES (FROM PERSONS NOT RELATED TO YOU)
Name / Relationship (friend, supervisor, co-worker, etc.) Phone
1)______________________________________________ _________________________
2)
______________________________________________ _________________________
3)______________________________________________ _________________________
7. VETERAN’S PREFERENCE: THIS RESPONSE IS VOLUNTARY.
ARE YOU A QUALIFIED VETERAN REQUESTING VETERAN’S PREFERENCE? YES NO
IN ORDER TO RECEIVE VETERANS PREFERENCE POINTS YOU MUST COMPLETE THE VETERANS PREFERANCE FORM AND
PROVIDE A DD-214 OR DD-215. DID YOU ATTACH THE REQUIRED DOCUMENTATION FOR REQUESTING VETERAN’S
PREFERRENCE? YES
NO
CERTIFICATION AND SIGNATURE
I certify that all information given on this application and any supporting information is true and complete
and I authorize a complete investigation. I agree that, if hired, I may be discharged if the County at any time
learns of any falsification or material omission in the information I have provided and if discovered prior to hire, I
would be ineligible for consideration for not only this position but future positions as well. I authorize the County
to contact all former and current employer references listed and all educational institutions.
I understand that a consumer report regarding my credit worthiness, credit standing, credit capacity,
character, general reputation, personal characteristics, or mode of living, whichever are applicable, may be
obtained for employment purposes from a consumer reporting agency.
I authorize all references to release to Yamhill County all information requested which they might have
about me. I hereby release all references and Yamhill County from any liability which might be claimed because
of information provided by such references.
I agree that, if hired, I will follow all County policies, rules, procedures and all other directions. I
understand I may terminate my employment at any time and for any reason without prior notice. I agree that if I
am hired, I will be employed at the will of Yamhill County, and my employment can be terminated at any time,
with or without notice, subject to applicable Collective Bargaining Agreement or other processes as defined in
county policy.
I understand Yamhill County is committed to promoting safety and high standards of employee
performance, productivity and reliability and that in order to achieve this, all finalists may be subjected to a drug
test prior to being hired to assure the County the applicants do not currently have narcotics, sedatives,
stimulants, and other controlled substances and/or hallucinogenic in their bodies. I understand that if I have any
such substance in my body at the time of the drug test, the County will not hire me. I further understand that at
any time during my employment with Yamhill County, my supervisor or any other manager may require, as a term
and condition of continued employment, a substance test if they have a reasonable suspicion that I am under the
influence of any substance that might result in harm to myself or to others.
I further understand that if I am selected as a finalist for any position with Yamhill County, the County may
do an investigation of criminal convictions. Note for Health and Human Service Applicants: ORS 443.004 is
now in effect for individuals hired on or after July 28, 2009 or who were subject to a background check on or after
July 28, 2009. It directly impacts the background check process. In this legislation, public funds may not be used
to support, in whole or in part, the employment in any capacity of individuals in certain positions if the individual
has specific convictions.
I understand the County reserves the right to add to, change, and/or delete its policies, procedures, work
rules and benefits at any time and that no one in the County has the authority to enter into any agreement for any
particular period of time or contrary to the above terms, unless that agreement is set forth in writing and signed by
the Yamhill County Board of Commissioners.
I have read and understand the above information.
X______________________________________ ______________________
SIGNATURE OF APPLICANT DATE
NOTE: An applicant’s signature on this statement is a requirement of the application process. No further
consideration will be given to any application submitted without signature.
Return application to:
Yamhill County Employment
Office Location: 434 NE Evans Street, McMinnville
Mailing address: 535 NE 5th Street, McMinnville, Oregon 97128
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APPLICANT
DATA RECORD
This information is requested solely for the purpose of determining compliance with government
regulations and affirmative action responsibilities. Your response will not affect consideration of your
application. This data is for periodic government reporting and will be kept in a confidential file separate
from the application for employment.
NAME _______________________________________________________ Date_________________
POSITION APPLIED FOR ____________________________________________________________
GENDER: Male ____ Female ____
RACE / ETHNIC ORIGIN (see definition below)
___ Hispanic or Latino
___ White (Non-Hispanic or Latino)
___ Black or African American (Non-Hispanic or Latino)
___ Asian (Non-Hispanic or Latino)
___ Native Hawaiian or Other Pacific Islander (Non-Hispanic or Latino)
___ American Indian or Alaskan Native (Non-Hispanic or Latino)
___ Two or More Races (Non-Hispanic or Latino)
DEFINITIONS
The racial and ethnic categories for Federal statistics and administrative reporting are defined as follows:
ETHNICITY:
Hispanic: A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin,
regardless of race.
RACE:
White (Non Hispanic or Latino) – All persons having origins in any of the original peoples of Europe, North Africa or
the Middle East.
Black or African American (Non Hispanic or Latino) - A person having origins in any of the black racial groups of
Africa.
Asian (Non Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia,
or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam.
Native Hawaiian or Other Pacific Islander (Non Hispanic or Latino) - A person having origins in any of the peoples
of Hawaii, Guam, Samoa, or other Pacific Islands.
American Indian or Alaska Native (Non Hispanic or Latino) - A person having origins in any of the original peoples
of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races (Non Hispanic or Latino) - Persons who identify with two or more racial categories named above.
_____________________________________________ ____________________
Signature Date
FORM SEPT2015
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EMPLOYMENT APPLICATION (Columbia Gorge Community College)

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Completed 30 May 2021

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