Employment Application ‣ Recovery Begins Here: (360) 876-9430

Employment Application

Date

MM slash DD slash YYYY

Name

First Last

Best phone number to reach you

Alternate number

Address

Street Address City State / Province / Region ZIP / Postal Code

EMPLOYMENT DESIRED

Position applying for:

Referral Source:

Are you applying for:

Regular full-time work

Regular part-time work

Internship

What days and hours are you available for work?

If applying for temporary work, during what period of time will you be available?

Are you available for work on nights?

Yes

If hired, on what date can you start work?

Salary desired:

PERSONAL INFORMATION

Have you ever applied to work for West Sound Treatment Center?

Yes

If yes, when?

Do you have any friends or relatives working for West Sound Treatment Center?

Yes

If hired, would you have a reliable means of transportation to and from work?

Yes

Do you have the legal right to work in the United States? (Note: Proof of identity and legal authority to work in the U.S. is a condition of employment)

Yes

Have you ever been convicted of a crime other than a traffic violation?

Yes

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

EDUCATION & TRAINING

High school name & address, No. of years completed, Did you graduate?

College/University name & address, No. of years completed, Did you graduate?, Name of degree/certification

Vocational/Business school name & address, No. of years completed, Did you graduate?, Name of degree/certification

Other relevant education/training

Some of our clients may not speak English. Do you speak, write, or understand any other languages?

Yes

If yes, which language(s)?

Do you have a SUDPT or SUDP credential?

Yes

Do you have any other experience, training, qualifications or skills which you feel make you especially suited to work for WSTC? If so, please explain:

EMPLOYMENT HISTORY

Are you currently employed?

Yes

May we contact your current employer?

Yes

Please list all present and past employment starting with your most recent employer (last ten [10] years is sufficient)

Name of most recent employer

Type of Business:

Supervisor's Name

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Starting date:

Ending date:

Starting Pay:

Ending Pay:

Reason for leaving:

May we contact this employer?

Yes

Name of previous employer

Type of business

Supervisor's name

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Starting date:

Ending date:

Starting pay:

Ending pay:

Reason for leaving:

May we contact this employer?

Yes

Name of previous employer

Type of business

Supervisor's name

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Starting date:

Ending date:

Starting pay:

Ending pay:

Reason for leaving:

May we contact this employer?

Yes

Name of previous employer

Type of business:

Supervisor's name:

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Starting date:

Ending date:

Starting pay:

Ending pay:

Reason for leaving:

May we contact this employer?

Yes

Please identify and explain all periods of unemployment in the past 10 years

MILITARY SERVICE

Have you obtained any special skills or abilities during military service?

Yes

If so, please describe:

REFERENCES: Please list three persons (not related to you) who have knowledge of your work performance within the past three years

Name:

Occupation:

Address

City State / Province / Region

Phone

Number of years acquainted:

Name:

Occupation:

Address

City State / Province / Region

Phone

Number of years acquainted:

Name:

Occupation:

Address

City State / Province / Region

Phone

Number of years acquainted:

Upload Resume

File

Max. file size: 450 MB.

ACKNOWLEDGEMENT

Please read carefully, check the agreement box beside each paragraph, and sign below.

I hereby certify that the information contained in this application is true and correct to the best of my knowledge. I further cetify that I, the undersigned applicant, have personally completed this application. I understand that any misrepresentation, falsification, or omission of information on this application or any document used to secure employment shall be grounds for rejection of this application or immediate discharge if I am employed, regardless of the time elapsed before discovery.

I agree

I hereby authorize WSTC to thoroughly investigate the information on my application, my references, work record, education, and other matters related to my suitability for employment and, further, authorized the references I have listed to disclose to WSTC all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release WSTC, my former employers, and all other persons or entities from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosures.

I agree

WSTC adheres to a policy of AT-WILL employment, which means that each employee and WSTC each retain the right to terminate the employment relationship and that WSTC retains the right to modify an employee's position or compensation at any time, with or without cause or notice. No one other than the CEO has the authority to make any binding promise or enter into any agreement inconsistent with WSTC's at-will policy, and any such agreement must be in writing and signed by both the employee and the CEO to be effective.

I agree

By typing your name below, you are signing this application electronically:

Date

MM slash DD slash YYYY