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Steps
1.
Step One
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2.
Personal Information
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3.
Position Information
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4.
Education and Training
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5.
Employment History
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6.
Professional References
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7.
Acknowledgements
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Step One
CITY OF ANACORTES
P.O. Box 547, 904 6th Street, Anacortes, WA 98221 (360) 299-1970 | FAX (360) 299-1982 | www.anacorteswa.gov
APPLICATION FOR EMPLOYMENT
The City of Anacortes is an equal opportunity employer. All applicants will be considered regardless of race, color, national origin, creed, religion, sex, age (over 40), pregnancy, marital status, physical or mental disability, genetic information, gender identification, sexual orientation, gender identity or status as an honorably discharged veteran, or any other class protected by federal, state, or local law. Equal access to the hiring process, services, and employment is available to all persons. Applicants requiring accommodations to the application and/or interview process should contact a representative of the Human Resource Department.
Instructions:
Each question should be answered completely and accurately. To be able to save and return to your application later, use google Chome as the web browser. Applicants are required to fill out a separate application for each position for which they apply. A completed City of Anacortes application is required for all positions; resumes may be submitted but will not be accepted as a substitute for a completed Employment Application. Please answer each question completely; unsigned or incomplete applications will not be considered. Verification of eligibility to work in the U.S. will be required if an employment offer is made.
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Personal Information
First name
*
Middle Initial
Last Name
*
Please list any other name(s) used during employment or education:
Address 1
*
Address 2
City
*
State
*
Zip Code
*
Cell Phone Number
Phone Number
*
Email Address
*
Driver's License Number
Must have a valid WA state Driver's License
Are you at least 18 years of age?
*
Yes
No
Can you provide proof of legal eligibility for employment in the U.S. within three business days of the date employment begins?
*
Yes
No
Upload Your Cover Letter
Upload Your Resume
Other Document(s)
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Position Information
List specific position applying for:
*
Where did you learn of this opening?
Have you filed an application here before?
Yes
No
If yes, give date
If yes, give date
Have you been employed here before?
Yes
No
If yes, give date
If yes, give date
Are any of your relatives presently employed with the City of Anacortes?
Yes
No
If yes, please provide names of relatives, their positions, and departments.
Do you have any commitments or other conflicts that would affect your promptness and/or regular attendance for this position?
Yes
No
If yes, explain.
Date available for work
Date available for work
Will Accept
*
Regular Full Time
Regular Part Time
Shift Work
Temporary
Seasonal
Internship
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Education and Training
High School Name & Location
Course of Study/Degree Received
Undergraduate Name & Location
Course of Study/Degree Received
Graduate Name & Location
Course of Study/Degree Received
Vocational/Technical Name & Location
Course of Study/Degree Received
Related Certificates or Licenses
Other related seminars or training
English Language
Speak
Read
Write
Other language
Other Language
Speak
Read
Write
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Employment History
Starting with your current or most recent employer, please list your employment history, including military and voluntary service assignments.
Present/Last Employer
Title/Position
Address
Hours per week
Date Started
Date Started
Date Ended
Date Ended
Name & Title of Supervisor
Supervisor Phone Number
Specific Duties
Reason for leaving
Eligible for Reemployment?
Yes
No
May we contact your previous supervisor for a reference?
Yes
No
Next Employer
Title/Position
Address
Hours per week
Date Started
Date Started
Date Ended
Date Ended
Name and Title of Supervisor
Supervisor Phone Number
Specific Duties
Reason for leaving
Eligible for Reemployment?
Yes
No
May we contact your previous supervisor for a reference?
Yes
No
Next Employer
Title/Position
Address
Hours per week
Date Started
Date Started
Date Ended
Date Ended
Name and Title of Supervisor
Supervisor Phone Number
Specific Duties
Reason for Leaving
Eligible for Reemployment?
Yes
No
May we contact your previous supervisor for a reference?
Yes
No
Next Employer
Title/Position
Address
Hours per week
Date Started
Date Started
Date Ended
Date Ended
Name & Title of Supervisor
Supervisor Phone Number
Specific Duties
Reason for Leaving
Eligible for Reemployment?
Yes
No
May we contact your previous supervisor for a reference?
Yes
No
Please explain any break in employment history.
JOB RELATED QUALIFICATIONS
List any additional skills, abilities, volunteer activities, awards, trades, businesses, civic associations or any offices held or other experiences not included above that you feel are relevant to the job for which you are applying.
Computer Skills
-- Select One --
None
Beginner
Intermediate
Highly Proficient
List systems and software used.
List any additional information which may more fully describe your qualifications and capabilities.
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Professional References
Please list three work-related references that have knowledge of your character and abilities, in addition to the supervisors listed in the Employment History Section. Do not list relatives.
Full Name
Job Title
Employer
Relationship
Address
Phone Number
E-Mail Address
Years known
Full Name
Job Title
Employer
Relationship
Address
Phone Number
E-Mail Address
Years Known
Full Name
Job Title
Employer
Relationship
Address
Phone Number
E-Mail Address
Years Known
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Acknowledgements
Accuracy of Information. I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration for employment, or for termination if employed.
Information Release. I authorize the City of Anacortes to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, qualifications, driving record, and other job-related information. I give my full consent for all contacted persons, including former employers, to provide the information concerning this application. Further, I waive my right to bring a claim against these individuals for any damages arising from furnishing the requested information to the City of Anacortes. I also release the City of Anacortes from all liability that might result from checking such references.
Drug Testing. A post-offer drug and/or physical examination may be required. I understand that, as allowed by the Americans with Disabilities Act, any offer of employment may be withdrawn if I test positive for drugs and/or if a condition is discovered which does not permit me to perform the essential functions of the job and for which no reasonable accommodation can be made.
Application Status. I understand that this application is current for only 60 days. At the conclusion of this time, if I have not heard from the City of Anacortes and still wish to be considered for employment, it will be necessary to fill out a new application.
In the event of my employment with the City of Anacortes, I will comply with all rules, regulations, and policies set forth in the City’s Personnel Policies or the communications distributed by the City. I also understand that the City has the right to modify its policies without giving me any advance notice of the changes.
AT-WILL EMPLOYMENT. I UNDERSTAND THAT IF I AM HIRED, MY EMPLOYMENT AT THE CITY OF ANACORTES IS “AT-WILL” AND MAY BE TERMINATED BY ME OR BY THE CITY OF ANACORTES AT ANY TIME FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. I UNDERSTAND THAT NO EMPLOYMENT OFFER IS BEING MADE BY THE CITY OF ANACORTES AT THIS TIME. I ALSO UNDERSTAND THAT NOTHING IN THIS APPLICATION IS INTENDED TO IMPLY OR CREATE AN EMPLOYMENT CONTRACT AND THAT NO CITY OF ANACORTES REPRESENTATIVE HAS THE AUTHORITY TO MAKE ANY ASSURANCE TO THE CONTRARY.
I am providing the electronic equivalent of my signature and assert that I have read, understood and agree that the information in this employment application is true and correct to the best of my knowledge.
Applicant Signature
*
Authorization to Past Employer, School, or Other Institution to Release Information
I have applied for employment with the City of Anacortes. As part of the application process the City of Anacortes conducts a reference check. I therefore authorize and request that you furnish relevant, job-related information to the City of Anacortes and/or its agents in connection with this application. I release from liability and I agree not to assert any claims or causes of action against all persons, corporations, and organizations supplying this information to the City of Anacortes and/or its agents. A photocopy of this authorization is as effective as the original.
Applicant Signature
*
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