Application for Employment

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155 W. Clay St.	Ph: (503) 838-3976
Monmouth, OR 97361	Fax: (503) 838-3002
	hr@ronwilsoncenter.com

Equal access to programs, services, and employment is available to all persons. Those applicants requiring a reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.
***PLEASE NOTE: Please fill in ALL blanks. If something does not apply, please put “n/a”. A resume may be attached; however, a resume does not take the place of a completed application.
Name*

Last NameFirst NameMiddle Name
Date

MonthDayYear
Date of Application
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Phone*

Area CodePhone Number
Secondary Phone

Area CodePhone Number

Employment History
Please provide the following information for your four (4) most recent employers, assignments, or volunteer activities with the most recent first.
Employer*
Phone Number*

Area CodePhone Number
Your Job Title*
Company Address*
Supervisor*
Reason for Leaving*
Supervisor Job Title*
Employed From*

MonthDayYear
Employed To*

MonthDayYear
Summary of responsibilities/duties*
May we contact for a reference?*

YesNo
Employer
Phone Number

Area CodePhone Number
Your Job Title
Company Address
Supervisor
Reason for Leaving
Supervisor Job Title
Employed From

MonthDayYear
Employed To

MonthDayYear
Summary of responsibilities/duties
May we contact for a reference?

YesNo
Employer
Phone Number

Area CodePhone Number
Your Job Title
Company Address
Supervisor
Reason for Leaving
Supervisor Job Title
Employed From

MonthDayYear
Employed To

MonthDayYear
Summary of responsibilities/duties
May we contact for a reference?

YesNo
Employer
Phone Number

Area CodePhone Number
Your Job Title
Company Address
Supervisor
Reason for Leaving
Supervisor Job Title
Employed From

MonthDayYear
Employed To

MonthDayYear
Summary of responsibilities/duties
May we contact for a reference?

YesNo

Education Background
High School*

YesNo
Years Completed*
Did you graduate?*

YesNo
Major/Course of Study*
Degree Earned*

GED*

YesNo
Years Completed*
Did you graduate?*

YesNo
Major/Course of Study*
Degree Earned*

College*

YesNo
Years Completed*
Did you graduate?*

YesNo
Major/Course of Study*
Degree Earned*

Other*

YesNo
Years Completed*
Did you graduate?*

YesNo
Major/Course of Study*
Degree Earned*

References

*References (Please note we are required by the State of Oregon to have three references. If we do not have three references we may not be able to process your application. If you have indicated we may contact previous employers as a reference then these may be either personal references or additional professional references)
Name*

First NameLast Name
Company/Organization*
Phone Number*

Area CodePhone Number
How do you know this person?*
Years Known*
Name*

First NameLast Name
Company/Organization*
Phone Number*

Area CodePhone Number
How do you know this person?*
Years Known*
Name*

First NameLast Name
Company/Organization*
Phone Number*

Area CodePhone Number
How do you know this person?*
Years Known*

I understand that if I am employed, any misrepresentation or material omission made by me on this application may be sufficient cause for cancellation of this application and immediate discharge from Ron Wilson Center’s service, whenever it is discovered.

I give Ron Wilson Center the right to contact and obtain information from all references, employers, educational institutions, and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability Ron Wilson Center and its representatives for seeking, gathering, and using information and all other persons, corporations, or organizations for furnishing such information.

Ron Wilson Center is an equal opportunity employer and does not discriminate on the basis of race, religion, color, sex, age, national origin, disability, veteran status, or any other classification protected by law.

This application is current for only 60 days. At the conclusion of this time, if I have not heard from Ron Wilson Center and still wish to be considered for employment, it will be necessary to fill out a new application.

Ron Wilson Center is an employment-at-will company. That means that both the employer and employee can terminate the employment relationship at any time, for any reason not prohibited by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of Ron Wilson Center, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. I understand that I will be subject to a Background Check. I understand that any offer of employment is subject to the completion of a Background Check that is satisfactory to Ron Wilson Center, the insurance carrier, and the State of Oregon.

I represent and warrant that I have read and understand the foregoing and seek employment under these conditions.
Signature of Applicant *
Date*

MonthDayYear
Date
Please upload your resume here.

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