EMPLOYMENT HISTORY. Start with present or last job and work back. Include military service and periods of unemployment of a
month or more. Include appropriate volunteer experience. Be as complete as possible in outlining the duties of each position.
Failure to do so may affect the credit you receive for experience, or your status as an employee, if hired.
Employed by: (Agency or Firm) Your Duties:
Street Address
City & State
Your Job Title
Supervisor’s Name/Title
Supervisor’s Telephone No. ( )
Employed From (Mo./Yr.) To (Mo/Yr. Reason For Leaving:
Starting Salary $ Final $ Avg. Hrs./Wk.
May we contact this employer _____No _____Yes
Employed by: (Agency or Firm) Your Duties:
Street Address
City & State
Your Job Title
Supervisor’s Name/Title
Supervisor’s Telephone No. ( )
Employed From (Mo./Yr.) To (Mo/Yr. Reason For Leaving:
Starting Salary $ Final $ Avg. Hrs./Wk.
May we contact this employer _____No _____Yes
Employed by: (Agency or Firm) Your Duties:
Street Address
City & State
Your Job Title
Supervisor’s Name/Title
Supervisor’s Telephone No. ( )
Employed From (Mo./Yr.) To (Mo/Yr. Reason For Leaving:
Starting Salary $ Final $ Avg. Hrs./Wk.
May we contact this employer _____No _____Yes
Employed by: (Agency or Firm) Your Duties:
Street Address
City & State
Your Job Title
Supervisor’s Name/Title
Supervisor’s Telephone No. ( )
Employed From (Mo./Yr.) To (Mo/Yr. Reason For Leaving:
Starting Salary $ Final $ Avg. Hrs./Wk.
May we contact this employer _____No _____Yes
Employed by: (Agency or Firm) Your Duties:
Street Address
City & State
Your Job Title
Supervisor’s Name/Title
Supervisor’s Telephone No. ( )
Employed From (Mo./Yr.) To (Mo/Yr. Reason For Leaving:
Starting Salary $ Final $ Avg. Hrs./Wk.
May we contact this employer _____No _____Yes
Attach supplemental sheets, if required.
AUTHORIZATION AND CERTIFICATE
I authorize Skagit County at the time of my application for employment or during the course of employment, to verify
information contained in this application as it relates to the position for which I am being considered, or in which I may be
employed.
I certify my statements in this application are true, complete and correct to the best of my knowledge and belief. I understand
any falsification or omission of information may bar me from the examination, remove my name from the eligibility list, or if I
have been appointed, cause my dismissal from Skagit County. I understand all statements made on this application may be
investigated.
Federal Law requires anyone employed by the County to present proof of identity and proof of authorization to work in the
United States. I understand I must be able to prove this authorization.
I understand that any offer of employment is contingent upon my agreeing to submit to and obtaining satisfactory results from a
pre-employment urine drug screen. A physical examination may also be required for specific positions. All candidates should
be advised to consider delaying notice of resignation to a present employer or refrain from rejecting other employment offers
until contingencies upon which Skagit County’s offer was made have been satisfied.
Date: _____________________________Signature: X_____________________________________________________________
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