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Clinical
Primary Care Clinics/SBHC
>
Clatskanie SBHC
Lions Wellness Center
Rainier Health Center
Sacagawea Health Center
Spencer Health & Wellness
MyChart
Family Planning & Reproductive Health
>
Contraceptive Services
Cancer Screenings
STD Testing
Immunizations
Clinical Referrals
WIC
WIC FAQ
Nutrition Services
Breastfeeding Support
Behavioral Health
Prevention
>
Quit Smoking
Suicide
Classroom Lessons
Problem Gambling
Parenting
Columbia Health Coalition
Oregon Health Plan Assistance
Resources
Data
Community Resources
Calendar
About Us
Careers
Clinical Providers
Contact Us
Our Board
Forms
Donate
Gear for Sale
Employment application
This facility does not permit discrimination because of race, color, sex, age, handicap or national origin in accordance with 45 C.F.R. 84.7(b) of
the Rehabilitation Act of 1973.
Applicant Information
*
Indicates required field
Name
*
First
Last
Email
*
Phone Number
*
Desired Salary
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Social Security Number
*
Which position are you applying for?
*
Date Available
*
1. Are you authorized to lawfully work for any employer in the United States?
*
Yes
No
2A. Have you ever worked for this company?
*
Yes
No
2B. If yes, when?
*
Education, Skills, and credentials
Name of High School
*
High School Address
*
Did you graduate?
*
Yes
No
I have a GED
College Name (if n/a type "n/a")
*
Degree (if n/a type "n/a")
*
College Address (if n/a type "n/a")
*
Dates attended (if n/a type "n/a")
*
Did you graduate
*
Yes
No
Still in attendance
n/a
Other education
*
Address
*
Dates attended
*
Did you graduate?
*
Yes
No
Still in attendance
Please list all job related skills, licenses, professional registrations, etc you have:
*
If you served in the armed forces please list the branch, your rank at discharge, dates of service, and if you had a non-honorable discharge please explain:
*
Employment
E1: Name of current/most recent employer
*
E1: Address for current/most recent employer
*
E1: Job Title
*
E1: Dates of employment
*
E1: Supervisor
*
E1: Employer contact phone
*
E2: Name of 2nd most recent employer
*
E2: Address for 2nd most recent employer
*
E2: Job Title
*
E2: Dates of employment
*
E2: Supervisor
*
E2: Employer contact phone
*
E3: Name of 3rd most recent employer
*
E2: Address for 2nd most recent employer
*
E3: Job Title
*
E3: Dates of employment
*
E3: Supervisor
*
E3: Employer contact phone
*
E1: Job Responsibilities
*
E1: Reason for leaving
*
E1: May we contact this employer for a reference?
*
Yes
No
E2: Job Responsibilities
*
E2: Reason for leaving, if N/A type "N/A"
*
E2: May we contact this employer for a reference
*
Yes
No
N/A
E3: Job Responsibilities
*
E3: Reason for leaving this employer, if N/A type "N/A"
*
E3: May we contact this employer for a reference
*
Yes
No
N/A
Resume (Required)
*
Max file size: 5MB
Attach Resume
Cover Letter
*
Max file size: 5MB
Other Document (as needed)
*
Max file size: 5MB
By submitting this form I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Submit
Clinical
Primary Care Clinics/SBHC
>
Clatskanie SBHC
Lions Wellness Center
Rainier Health Center
Sacagawea Health Center
Spencer Health & Wellness
MyChart
Family Planning & Reproductive Health
>
Contraceptive Services
Cancer Screenings
STD Testing
Immunizations
Clinical Referrals
WIC
WIC FAQ
Nutrition Services
Breastfeeding Support
Behavioral Health
Prevention
>
Quit Smoking
Suicide
Classroom Lessons
Problem Gambling
Parenting
Columbia Health Coalition
Oregon Health Plan Assistance
Resources
Data
Community Resources
Calendar
About Us
Careers
Clinical Providers
Contact Us
Our Board
Forms
Donate
Gear for Sale