NAME:______________________________________________________________ Please Print DATE:_______________________________________________________________ APPLICATION FOR EMPLOYMENT 345 E. COLUMBIA RIVER HWY TROUTDALE, OR 97060 (503) 489 6565 www.alsoweb.org *All ALSO applicants must complete and pass a pre-employment drug screen prior to becoming an employee. *Turning in an application for employment does not imply that applicant will be granted an interview. We are an equal opportunity employer. It is the policy of this organization to consider all applicants and employees without regard to race, color, religion, political preference, marital status, national origin, veteran status, gender, age, sexual orientation, gender identity, marital status, mental or physical disability and pregnancy, veteran status or other protected status or activity in accordance with applicable federal and state laws. Name: _______________________________________ Former Surname(s): __________________________________ Address: _________________________________________________________________________________________ Phone: ______________________________________ Social Security #: _____________________________________ Position Applied for: _____________________________Are you 18 yrs of age? ___Yes ___No Date Available for Employment? __________________Hours Available? _________________________ Please answer the following questions Y or N _____ ALSO provides care for developmentally challenged individuals 24 hours per day, 7 days a week, and 52 weeks a year. Working overtime is expected, if needed. Answering emergency calls for help is expected. Are you able to meet this requirement? ____ Can you perform the essential functions of the job duties listed on the job description for the position you have applied? (See attached job description) If no, what accommodations could we make to enable you to perform the work required? _________________________________________________________________________________________________ ____ Are you lawfully permitted to work in the United States? ____Do you have any communicable/contagious disease (airborne or transferable through food handing, etc.) If yes, please describe what accommodations, if any you would need. _________________________________________________________________________________________________ Have you ever been convicted of a crime, other than minor traffic violations? If “YES” state the date, location and a description of each conviction: _________________________________________________________________________________________________ _________________________________________________________________________________________________ Are you currently out on bail or awaiting trial on a pending criminal matter? Please explain.(answering “yes” regarding convictions or pending charges will not automatically disqualify you.) _________________________________________________________________________________________________ _________________________________________________________________________________________________ If yes, may we have permission to run your criminal history background report? _____Yes _____ No Initial Here: ____________ ____ Have you ever been administratively determined by a federal state or local governmental agency to have committed abuse or neglect? If yes, state when, where and the nature of the case. _________________________________________________________________________________________________ ____ Have you been employed by this organization before? If yes, list date(s) employed, site & supervisor name: _________________________________________________________________________________________________ ____ Are you related to any current ALSO employees or people that we support? If yes, list their names here: ________________________________________________________________________________________________________________________ 2 Revised 10/14 How did you hear about this job opening? Online? __________________ Family/Friend? ______________________ Other? ____________________________ Did a current ALSO employee refer you? List employee’s name: ___________________________________________ In case of an emergency who would you like us to contact? (please print) ______________________________________________________________________________________________ First & Last Name Address Phone Answer Y/N _____ Do you currently have a valid driver’s license? If yes, list license #__________________________ State_____ _____ Do you have any license restrictions? _____ Do you have valid auto insurance? _____ Has your license been suspended/revoked in the last 3 years? _____ Do you have any tickets? _____ Have you had any auto accidents whether you were at fault or not? List details here: ______________________________________________________________________________________________ _____Do you give ALSO permission to request your DMV Motor Vehicle Record? Educational Background See Resume_______ High School attended: ___________________________ Years:__________________ Did you graduate? ______________ If not, did you obtain a GED? ________________________ Please state name of degree achieved, school/training and dates of any additional education, special skills, or other experience related to the job you are seeking: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Do you have current training or certificate in any of the following? _____CPR/First Aid _____CNA _____ Medication Administration _____RN _____OAR’S _____ Client Rights _____Lifting _____Behavior Management Additional Training: ___________________________________________________________________________ ___________________________________________________________________________________________ __________________________________________________________________ 3 Revised 10/14 Employment Record & References (We must be able to verify a minimum of 2) See Resume ______ (if you choose “see resume” please include reason for leaving) Please list most recent employers first:. Job Title Employer City/State/Phone # Dates Employed Reason for Leaving Supervisor Name 1. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 2. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 3. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 4. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 4 Revised 10/14 PERSONAL REFERENCES (please print) First & Last Name 1. City/State Phone # Relationship (do not include family) ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 2. ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 3. ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Please read the following statements carefully before signing this application. Only those applications that are signed and dated are considered valid. If you have any questions regarding this statement, please ask before signing. 1. All answers and statements I have made on this application and resume or other supplementary materials are true and complete without omissions. I understand that any false information or omissions may be grounds for refusal to hire me or for immediate discharge if I am employed. I authorize ALSO to obtain information about me from any of the prior employers or persons named in this application or provided by me as references. I also agree to sign an authorization releasing these prior employers and persons of liability for providing such information. Initial Here: __________________ 2. I understand that if I am hired my employment can be terminated for any reason and at any time without notice, at the options of the employer or myself, except as prohibited by law. I also understand that no representative of ALSO has authority to enter into an employment agreement for a specified period of time, or to make promises regarding any future position, benefits, or terms and conditions of employment, except in a written agreement signed by Brett Turner, CEO of ALSO. Initial Here:___________________ 3. I understand that there may be conditions imposed by the company prior to a final decision to hire me, including passing a preemployment drug test for the presence of unlawful drugs, consistent with applicable laws. Initial Here: __________________ I hereby release ALSO and the above referenced organizations, reference persons and employers form all claims, liability and damages that may result from furnishing the information to you. I expressly and fully waive all written notice from all prior employers. I also understand that because of the nature of my job and licensing requirements, I hereby consent to the release of this application or portions of this application to representatives of department of social services, department of mental health and community mental health agencies, or other governmental agencies. I further specifically waive written notice and agree to the divulging of any disciplinary reports, letters of reprimand or other disciplinary action by all prior employers and hereby release my prior employers from all claims, liability and damage that may result from furnishings the information to you. APPLICANTS SIGNATURE: ___________________________________________DATE:________ 5 Revised 10/14 HUMAN RESOURCE ADMINISTRATIVE ASSISTANT JOB DESCRIPTION Job Summary The Human Resource Administrative Assistant assists with the administration of the day-to-day operations of the human resources functions and duties. As the HR Administrative Assistant you will assist the Human Resource Director in all areas such as employment, employee relations, executive administration, etc. Essential Duties & Responsibilities (Other duties may be assigned as necessary)         Assist with all aspects of hiring new employees as directed by HR Director including but not limited to:  Initial screening of applicants  Tracking data  Scheduling interviews  Reference checks  Scheduling pre-employment drug screen  Maintain supply of related hiring materials such as applications, new hire packets, etc.  Assist newly hired employees with paperwork  Recruitment  Assist posting available positions Pay great attention to detail and timelines Must be able to manage multiple priorities/tasks with frequent interruptions Ability to take initiative Obey all HIPAA guidelines and ensure all data is confidential General business administrative skills and product knowledge Other duties and projects as assigned Promote professional work ethic, follow and adhere to ALSO’s policies and procedures, engage in ALSO’s effort to maintain environmentally sustainable practices, communicate in a positive and professional manner and promote ALSO within the community. Professional Qualifications & Competencies  High School Diploma or equivalent required  Must possess excellent communication skills (both verbal and written)  Ability to manage multiple priorities/tasks with frequent interruptions while achieving all assigned deadlines  Proficient computer skills including Microsoft Office, ability to comprehend and interpret general business documents, technical procedures, governmental regulations, etc.  Exceptional interpersonal and professional skills, ability to work independently and accept responsibility using ethical and moral behavior  Dynamic organizational skills and must comprehend basic financial skills  Must possess a valid drivers license, maintain acceptable driving record defined by ALSO’s driver policies and procedures, ability to pass a criminal history background investigation and pre-employment drug screen SIGNATURE:_____________________________________________DATE:_________ 6 Revised 10/14