Apply Online Leave this field blank Equal Employment Opportunity (optional) This application is not, by any means an employment contract but merely is intended to evaluate suitability for employment. It is the policy of HSYC to provide equal employment to all qualified persons without regard to race, color, sex, religion, age, marital status, national origin, citizenship, disability, veteran status, or any other status protected under state or federal laws. Applicants with disabilities may request reasonable accommodation to complete this application, or to take any test required for the position for which they have applied, by making a request at the time of application or testing. Today's Date Position Applying For Name: (First, Middle, Last) Address Phone Message Phone E-mail Are you at least 18? Yes No Are you eligible to work in the U.S.? Yes No If no, can you provide proof of identity and eligibility to work in this county? Yes No Do you have any relative/friend who currently works for us? (Qualified relative/friends are eligible for employment except in unusual situations where we need to avoid possible conflict of interest). Yes No How did you learn about this position? Have you applied with this organization before? Yes No If yes, please explain. Are you a current or past Head Start parent? Yes No If yes, please explain. Do you have a valid driver's license? Yes No Do you have reliable transportation? Yes No When are you available to work? If you are multilingual or bilingual, in which languages? (optional) If you are multilingual or bilingual, are you fluent in both conversation and in writing? (optional) Yes No Emergency Contact Name Emergency Contact Address Emergency Contact Phone High School/ GED School Name High School/ GED City & State High School/ GED Area of Study High School/ GED Degree Type College School Name (optional) College City & State (optional) College Area of Study (optional) College Degree Type (optional) Other Schooling/ Skills Training (optional) Other Schooling/ Skills Training City & State (optional) Other Schooling/ Skills Training Area of Study (optional) Other Schooling/ Skills Training Degree Type (optional) Employment History: (State all jobs you have had in the last 7 years; beginning with the most recent. If additional space is needed, the information can be submitted to Human Resources at a later time.) (optional) Company Name #1: Company #1 Address & Phone Dates of Employment Supervisor Name Position Held Your Duties Reason for Leaving Company Name #2 (optional) Company #2 Address & Phone (optional) Dates of Employment (optional) Supervisor Name (optional) Position Held (optional) Your Duties (optional) Reason for Leaving (optional) Company Name #3 (optional) Company #3 Address & Phone (optional) Dates of Employment (optional) Supervisor Name (optional) Position Held (optional) Your Duties (optional) Reason for Leaving (optional) Company Name #4 (optional) Company #4 Address & Phone (optional) Dates of Employment (optional) Supervisor Name (optional) Position Held (optional) Your Duties (optional) Reason for Leaving (optional) Personal Reference #1 (Full Name) Personal Reference #1 Address Personal Reference #1 Phone Personal Reference #2 (Full Name) Personal Reference #2 Address Personal Reference #2 Phone Professional Reference (Full Name) Professional Reference Address Professional Reference Phone Days Available to Work Monday Tuesday Wednesday Thursday Friday Saturday Sunday Locations Available to Work McMinnville Newberg Willamina/ Sheridan If applying for a classroom position, please list any EDUCATIONAL COURSEWORK you have had in: Early Childhood Education, Child Development, and/ or Family Relationships, or any coursework relative to the position you are applying for. Not all classroom positions require formal educational experience. Experience working with you children and families is equally important. However, any relevant coursework or workshops listed below will be considered. (Please include Date, Class Name or Description, Credits Earned, and the Educational Institution.) (optional) Please list any WORKSHOPS or additional training experience in Early Childhood Education, Child Development, and/ or Family Relationships you have taken. (Please include Date, Description, Credits Earned, and the Educational Institution.) (optional) Please describe any OTHER work or volunteer experience you have that relates specifically to the position for which you are applying, if you have not already listed that experience. (optional) Applicant Comments: If you would like to provide any additional comments or information you consider relevant to the position you are applying for, please use this space: (optional) Electronic Signature Start drawing Clear Done Start over Head Start of Yamhill County is an EQUAL OPPORTUNITY EMPLOYER. We hire and promote without regard to race, color, sex, national origin, religion, age or mental or physical handicaps unrelated to job performance. The following information is OPTIONAL and is used to implement and monitor Head Start of Yamhill County's Affirmative Action plan and will not be considered in the hiring process. (optional) Position Applied For (optional) Date (optional) Gender (optional) Male Female Other Handicap status: Are you considered handicap as defined by the Department of Health, Education, and Welfare? (optional) Yes No Ethnic Background (CHECK ONLY ONE) (optional) HISPANIC OR LATINO: All persons of Cuban, Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. WHITE (not Hispanic or Latino): All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East. BLACK OR AFRICAN AMERICAN (not Hispanic or Latino): All persons having origins in any of the black racial groups of Africa. ASIAN (not Hispanic or Latino): All persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent. This area includes, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER: All persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. AMERICAN INDIAN OR ALASKA NATIVE: All persons having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. TWO OR MORE RACES: All persons who primarily identifies with two or more of the above race/ ethnicity categories. Signature (optional) Start drawing Clear Done Start over Send
