Employment Application

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Page 1

An Equal Opportunity Employer:

FACT Oregon will make every effort to meet a request for disability accommodation. If you require accommodation to participate in our application process, please contact our office at managers@factoregon.org or (503) 786-6082 or (541) 695-5416.

Instructions:

Answer each question fully and accurately. No action can be taken on this application until all questions have been answered.

Complete this form to submit your application.

Your application won’t be admitted until you click the “Done” button at the end of this form.

Applicant Information

First Name

Last Name

Phone

Phone Type

Street Address

City

State

Zip Code

FACT Oregon Employment Interest

What position are you applying for?

When are you available for employment?

Are you eligible to work in the United States?

YesNo

Do you have any commitments or agreements with another employer which might affect your employment here?

YesNo

Have you ever applied to FACT Oregon before?

YesNo

Were you ever employed at FACT Oregon before?

YesNo

When did you previously apply at FACT Oregon?

When were you employed with FACT Oregon?

Page 3

Do you have work or volunteer history to share?

YesNo

Employer/Organization

Work and/or Volunteer History

Please provide your employment history and/or position relevant volunteer history.

List names of employers or volunteer organizations in consecutive order with present or last employer listed first.

If self-employed, give firm name and supply business references.

If you worked in any of the positions under another name, please give name(s).

Please give month and year.

Employer/Organization Name

Employer/Organization Address

CIty

State

Zip Code

Employer/Organization Phone Number

Position Held

Start Date

MM/DD/YYYY

Still Employed/Volunteering

YesNo

Duties

End Date

MM/DD/YYYY

Reason for Leaving

May we contact your employer/organization for a reference?

YesNo

Page 4

Describe experience that can be demonstrated to be applicable to the duties listed in the job description.

Cover Letter

Resume

Page 5

Affidavit

I certify that, to the best of my knowledge, the information contained in this application is true and complete. I understand that my employment may be denied or terminated if I provide false, misleading, or incomplete information during the hiring process or my employment.

I understand that, if I am hired, I must produce applicable documents confirming my identity and showing that I am lawfully authorized to work in the United States, in accordance with the Immigration Reform and Control Act of 1986, as amended.

I understand and agree that my prior employers, educational institutions, and other references, listed or not listed on this application, may be contacted by FACT Oregon. These references are authorized to give FACT Oregon any and all pertinent information they may have. I release all persons or entities involved, including FACT Oregon, from all liability arising from this contact and provision of information.

I authorize the FACT Oregon to conduct a criminal history check after an initial interview or conditional offer of employment and understand that unexpunged criminal convictions may be considered by FACT Oregon in making hiring decisions.

I agree to conform to all FACT Oregon’s policies, rules, and procedures.

Furthermore, I understand and agree that nothing contained in this employment application, the granting of an interview, or in the offer of employment, creates a contract for employment between FACT Oregon and myself. If an employment relationship is established, I understand that, unless specifically limited in an express, formally executed contract, I have the right to terminate my employment at any time and for any reason and FACT Oregon has the same right.

Submission Process

Submit and Review Your Application – After you click submit, you will be prompted to review your application for accuracy.

Provide Your Electronic Signature – You will then add your electronic signature to certify your application.

Verify Your Email Address – A verification email will be sent to the address you provided. You must verify your email to complete the e-signature process. Your application is not considered complete until this step is finished.

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