Employment Application

Instructions: Please fill out application completely; an incomplete application may disqualify you. Employment is contingent on the successful completion of a background check. You will be contacted if you are selected for an interview. You will be required to provide legal proof of your authorization to work in the United States within 3 days, if you are hired. Employment is contingent upon providing the required documentation. If you require any accommodation to complete the application or interview process, please call the WAPC Administration at (206) 517-2350.

PERSONAL DATA

Name(Required)

First Middle Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Are you age 18 or older?(Required)

Yes

Are you eligible to work in the U.S.?(Required)

Yes

Yes, with visa

If applicable, what type of work visa do you have?(Required)

How did you hear about the job opening?

POSITION DETAILS

Position Applying For(Required)

Work Availability(Required)

Full Time

Part Time

Standby/Per Diem

Temporary

Day

Evening

Night

Weekends

Date Available to work(Required)

MM slash DD slash YYYY

Salary Desired

WAIVER

I understand that employment is contingent on the successful completion of a background check, and if hired by the Washington Poison Center, my employment will be of indefinite duration. The Washington Poison Center or I will be free to terminate this employment relationship at will and at any time. I further understand that any representations to the contrary are unauthorized and void, unless contained in a formal written employment contract signed by an officer or administrator of the Washington Poison Center. I certify that the information set forth in this application is true and complete to the best of my knowledge. I understand that, if employed, I will be subject to immediate dismissal if I have made any false statements, misrepresentations, or provided incomplete information in this application. I authorize the Washington Poison Center to check all information contained in or related to this application, including employment references, records of law enforcement agencies, educational institutions and licensing agencies. I release the Washington Poison Center and any individuals or organizations providing references or background information from any liability arising out of giving or receiving of such information.

Signature(Required)

First Last

By typing my name on the signature line above I attest that the information entered is true and accurate to the best of my knowledge and belief.

Date(Required)

MM slash DD slash YYYY

WORK EXPERIENCE

1) Employer

Employer Name and location Position/Title // Dates employeed / Hours worked per week Supervisor name / May we contact your previous employer? Reason for Leaving Eligible for rehire?

2) Employer

Employer Name and location Position/Title // Dates employeed / Hours worked per week Supervisor name / May we contact your previous employer? Reason for Leaving Eligible for rehire?

3) Employer

Employer Name and location Position/Title // Dates employeed / Hours worked per week Supervisor name / May we contact your previous employer? Reason for Leaving Eligible for rehire?

4) Employer

Employer Name and location Position/Title // Dates employeed / Hours worked per week Supervisor name / May we contact your previous employer? Reason for Leaving Eligible for rehire?

5) Employer

Employer Name and location Position/Title // Dates employeed / Hours worked per week Supervisor name / May we contact your previous employer? Reason for Leaving Eligible for rehire?

Additional Employement information

Please account for any time gaps in employment, including any military service.

Resume/CV

A resume or CV is required for all professional positions.

Accepted file types: pdf, Max. file size: 50 MB.

Application for Employment

PERSONAL DATA

Name(Required)

First Middle Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Are you age 18 or older?(Required)

Yes

Are you eligible to work in the U.S.?(Required)

Yes

Yes, with visa

If applicable, what type of work visa do you have?(Required)

How did you hear about the job opening?

POSITION DETAILS

Position Applying For(Required)

Work Availability(Required)

Full Time

Part Time

Standby/Per Diem

Temporary

Day

Evening

Night

Weekends

Date Available to work(Required)

MM slash DD slash YYYY

Salary Desired

WAIVER

Signature(Required)

First Last

By typing my name on the signature line above I attest that the information entered is true and accurate to the best of my knowledge and belief.

Date(Required)

MM slash DD slash YYYY

WORK EXPERIENCE

1) Employer

Employer Name and location Position/Title // Dates employeed / Hours worked per week Supervisor name / May we contact your previous employer? Reason for Leaving Eligible for rehire?

2) Employer

Employer Name and location Position/Title // Dates employeed / Hours worked per week Supervisor name / May we contact your previous employer? Reason for Leaving Eligible for rehire?

3) Employer

Employer Name and location Position/Title // Dates employeed / Hours worked per week Supervisor name / May we contact your previous employer? Reason for Leaving Eligible for rehire?

4) Employer

Employer Name and location Position/Title // Dates employeed / Hours worked per week Supervisor name / May we contact your previous employer? Reason for Leaving Eligible for rehire?

5) Employer

Employer Name and location Position/Title // Dates employeed / Hours worked per week Supervisor name / May we contact your previous employer? Reason for Leaving Eligible for rehire?

Additional Employement information

Please account for any time gaps in employment, including any military service.

Resume/CV

A resume or CV is required for all professional positions.

Accepted file types: pdf, Max. file size: 50 MB.