204 East 6th Avenue
Ellensburg, WA 98926
509.925.6688

Elmview Employment Application

We consider application for all positions without regard to race, sex, age, religion, national origin, marital or veteran status, the presence of a non-job-related medical condition or disability, or any other legally protected status. Questions directly or indirectly reflecting such status have been included only where needed to determine a bona fide occupational qualification or other permissible purpose.

Required fields are marked with an asterisk (*).

*First Name *Last Name *SS#
*Address *City State *Zip
*Telephone *Email  
 
*Applying For: Seeking  

Previous Elmview employee? No Yes

If Yes When Position

Friend or relative employed by Elmview? No Yes

If Yes - Who Relationship to you

Are you currently authorized to work in the U.S? Yes No

Are you able to perform the essential functions of the job with or without reasonable accommodation? Yes No

Education:

Type Name of School Degree/Diploma Course of Study
High School or GED
College or University
Other Studies
References: (At least two must be work references)
First Name Last Name Occupation
Address City State Zip
Telephone Email

First Name Last Name Occupation
Address City State Zip
Telephone Email

First Name Last Name Occupation
Address City State Zip
Telephone Email

 
Employment: (Please start with your present or most current job)
Employer Name Title Start Date End Date
Address City State Zip
Supervisor Phone Number May we Contact
Yes No
Job Duties Reason for leaving

Employer Name Title Start Date End Date
Address City State Zip
Supervisor Phone Number May we Contact
Yes No
Job Duties Reason for leaving

Employer Name Title Start Date End Date
Address City State Zip
Supervisor Phone Number May we Contact
Yes No
Job Duties Reason for leaving

Employer Name Title Start Date End Date
Address City State Zip
Supervisor Phone Number May we Contact
Yes No
Job Duties Reason for leaving

 
Additional job related information, skills, and qualifications
 
Applicant Comments
 
 
I understand that if any information I have provided on this application is falsified it will jeopardize my employment chances or, if already employed I may be terminated. This application will not be considered complete until the applicant comes to the office, at 204 E 6th Ellensburg, or 1104 W Lincoln Yakima, and complete background and reference check forms. ***Elmview is an Equal Opportunity Employer***.
I agree to the above terms