Snohomish, WA - Official Website

Personal Information

First Name*
Last Name*
Physical Address*
Mailing Address*
City*
State*
Zip*
Phone Number*
Email Address*
Are you legally eligible for employment in the United States?*
1. Yes
2. No
Do you have a valid Washington State Driver's License? *
1. Yes
2. No
Are you available for full-time employment? If not, enter when you can work below.*
1. Yes
2. No
I am able to work the following schedule:
Have you ever worked for or are you acquainted with other City of Snohomish employees? *
1. Yes
2. No
If yes, who?
Are you 18 years or older?*
1. Yes
2. No
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Disability Status: A person with a disability is a person who has a physical or mental impairment which substantially limits one or more major life activities, or has a record of such impairment, or is perceived as having such an impairment as defined by the Americans with Disabilities Act. An accommodation may be necessary to provide a person with a disability equal employment opportunity.
Wil you need accommmodation due to disability in the application, testing or interview process?
1. Yes
2. No
Please provide a brief description of the accommodation requested:
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Position Information

Which open position are you applying for?*
Describe your abilities, knowledge and skills that qualify you for this position:*
List your licenses or certificates (professional or trade licenses or certificates required for this position)*
How did you hear about this position?*
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Education

High School or GED*
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Business or Technical
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Degree
Undergraduate Studies
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Degree
Graduate Studies
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Degree
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Employment History

Beginning with your present or most recent employment, list your employment history for the last ten (10) years. Please complete the following sections even if you are submitting a resume in addition to the application. An incomplete application may disqualify you. If you have been known by a different name by any of the following employers or educational institutions, please identify the employer/educational institution and state the name below:
(From Most Recent)
Employer's Name
Position Title
Supervisor
Phone Number
May we contact your employer?
1. Yes
1. No
If no, please state reason:
Address
Responsibilities
Reason for leaving (if still employed, indicate reason for wanting to leave).
Employed From - To (Date)
Salary
Employer's Name
Position Title
Supervisor
Phone Number
May we contact your previous employer?
1. Yes
1. No
If no, please state reason
Address
Responsibilities
Reason for leaving:
Employed From - To (Date)
Salary
Employer's Name
Position
Supervisor
Phone Number
May we contact your previous employer?
1. Yes
1. No
If no, please state reason:
Address
Responsibilities
Employed From - To (Date)
Salary
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Professional References

Please list three professional references.
Full Name*
Relationship*
Company*
Phone Number*
Full Name
Relationship
Company
Phone Number
Full Name
Relationship
Company
Phone Number
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Other

Accommodation: If you need accommodation in order to complete or participate in the application, testing or interview process, please notify the Human Resources Office at (360) 568-3115.
Equal Employment Opportunity: It is the policy of the City to provide equal opportunity for employment to all individuals regardless of race, color, religion, sex, national origin, age, veteran status, marital status, political affiliation, sexual orientation, the presence of sensory, mental or physical disability, or other basis prohibited by federal, state or local law. This policy applies to all areas of employment, including, but not limited to, recruitment, selection, placement, retention and separation.
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Disclaimer, Waiver and Signature

I, the below-signed, make this application as an inducement to this Employer to evaluate my application and to employ me. I have read this completed application, including the Equal Employment Opportunity statement, and I certify that entries made by me are without omission and are a full, truthful account of my present and past activities. I authorize and give the right to the City to make a thorough, vigorous investigation of all entries made on this form by me and other materials I have provided. Any false or misleading statement or entry on this form and other material I have provided will result in my immediate termination, if I am employed. I agree to prompt payroll deduction of overpayments made to me or amounts owed to the City.<br><br>Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
I, the below-signed, make this application as an inducement to this Employer to evaluate my application and to employ me. I have read this completed application, including the Equal Employment Opportunity statement, and I certify that entries made by me are without omission and are a full, truthful account of my present and past activities. I authorize and give the right to the City to make a thorough, vigorous investigation of all entries made on this form by me and other materials I have provided. Any false or misleading statement or entry on this form and other material I have provided will result in my immediate termination, if I am employed. I agree to prompt payroll deduction of overpayments made to me or amounts owed to the City.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*
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