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Yakima Health District Employment Application
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Steps
1.
Required Information
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2.
Skills & Qualifications
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3.
Previous Experience
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4.
Supplemental Documents
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Required Information
Position Applied For
*
Department
*
What is the reason you are looking for employment at this time?
*
Date
*
Date
First Name
*
Last Name
*
Middle Name
*
Email
*
Mailing Address
Address
*
City
*
State
*
Zip Code
*
Contact Information
Contact Phone Number
*
Home / Alternate Phone Number
Email
*
Other Details
Are you now or have you ever been employed by Yakima County?
*
Yes
No
If yes, give department and dates:
Do you have relatives employed by the County?
*
Yes
No
If yes, indicate name, relationship, and department:
There are some limitations on the employment of relatives. Each case is considered separately for potential conflict of interest.
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Skills & Qualifications
If you have taken a keyboarding exam within the last 12 months, please list score and date of exam.
Keyboard Score
This is only for positions requiring a keyboarding test.
Date of Test
Date of Test
Language Skills
Language
Spoken
Yes
No
Written
Yes
No
Language
Spoken
Yes
No
Written
Yes
No
Language
Spoken
Yes
No
Written
Yes
No
Computer Applications
List computer applications used
Equipment Skills
List the equipment you operated related to the job for which you are applying.
Licenses, Certifications & Registrations
Professional or trade licenses that are require for this position.
Document Name
Issued By
Number
Expiration Date
Expiration Date
Document Name
Issued By
Number
Expiration Date
Expiration Date
Document Name
Issued By
Number
Expiration Date
Expiration Date
Do you possess a valid Washington State driver's License?
Yes
No
A valid Washington State driver's license is required only where stated on the job announcement.
High School Graduate or General Education Development (GED) Test Passed?
Yes
No
Professional / Technical School
Name of Institution
Years / Credits Completed
Degree Earned / Major
Yes
No
Specialization
College / University
Name of Institution
Years / Credits Completed
Degree Earned / Major
Yes
No
Associate in Arts
Bachelor in Arts
Bachelor in Science
Major / Degree Title
Specialization
Graduate School
Name of Institution
Years / Credits Completed
Degree Earned / Major
Yes
No
Master of Arts
Master of Science
PhD
Major / Degree Title
Specialization
Other
Name of Institution
Years / Credits Completed
Degree Earned / Major
Yes
No
Specialization
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Previous Experience
Job 1
Employer
Address
City
State
Zip Code
Supervisor's Name
Supervisor's Title
Phone Number
Reason for Leaving
Employment Length
Employment Length Start Date
—
Employment Length End Date
Monthly Salary
Hours per Week
Your Title
Your Duties
Number of Employees You Supervised
May we contact this employer?
Yes
No
Job 2
Employer
Address
City
State
Zip Code
Supervisor's Name
Supervisor's Title
Phone Number
Reason for Leaving
Employment Length
Employment Length Start Date
—
Employment Length End Date
Monthly Salary
Hours per Week
Your Title
Your Duties
Number of Employees You Supervised
May we contact this employer?
Yes
No
Job 3
Employer
Address
City
State
Zip Code
Supervisor's Name
Supervisor's Title
Phone Number
Reason for Leaving
Employment Length
Employment Length Start Date
—
Employment Length End Date
Monthly Salary
Hours per Week
Your Title
Your Duties
Number of Employees You Supervised
May we contact this employer?
Yes
No
Continue
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Supplemental Documents
Upload Completed Equal Opportunity Employer Form
Upload Completed Applicant Disclosure & Authorization for Background Check
Upload College Transcripts if Required in the Job Post
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