APPLICATION FOR EMPLOYMENT This generic application is .provided by WorkSource Washington. This form complies with federal and state laws against discrimination; however, employers,using this form should check local ordininces. WorkSource Washington and Washington State Employment Securit,; are 1ot responsible for the mjsuse of information provided on this form. Provide all infonnation requested 6y printing in ihr br typing. Usi the 'TAB' key to move through the document. GENERAL INFORMATION POSITION EDUCATION AND TRATNING Position Or Type Or empryrnentEEGiEE' WillAccept: n Part-time I rutt-lime f] Temporary shift: E oay I swing I Graveyard l-l Rotatinq Are you able to perform the essential functions of the job you are applying for, with or without reasonable accommodationl f] yes f] No 5arary ueslred Date Available Name (Last) (First) (Middle lnitial) Home Telephone () ACrdress (Maiting Address) (city) (State) (zip) other Telephone () E-Mail Address - .....- Are you legally entitled to worX in the U.S.? n Yes n ruo High School Graduate Or General Education (GED) Test passed? [ yes lf no, list the highest grade completed n No College, Business School, Military (tV6st recent first) Name and Location Dates Attended Month/Year Credits Earned Graduate Degree & Year Major or Subject Quarterly or Semester Hours Other (Specify) From n Yes ENo To From D Yes ENo To From D Yes nruo To From n Yes E t'lo To Ltcense, certificate or Registration Number Where lssued Expiration Date License, Certificate or Registration Number Where lssued Expiration Date uccupattonat License, Certificate or Registration Number Where lssued Expiration Date Languages Read, Written or Spoken Fluenfly Other Than English VETERAN INFORMATION SPECIAL SKILLS nent skills and EMS 10171 CC 7540-032 635 ESD 1999 Rev.12l30l1i)