Health District Job Application

An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, sexual orientation, marital status, genetic information, or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors. Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

What job are you applying for? *

How did you hear about this position?

Please let us know how you heard about this job opportunity. If you were referred by a current Health District employee, please include their name.

What type of employment are you seeking? *

Full-Time Employment

Part-Time Employment

Temporary Employment

Name *

Please provide your full legal name in the following format: (First Name, Middle Initial, Last Name (if applicable)).

Maiden/Alias Name

Do you have a maiden name or an alias you have used previously that we should be aware of?

Preferred Name

Do you have another name you prefer us to use?

Preferred Pronouns

she/her

he/him

they/them

Please select the pronouns you prefer to be referred to by. Multiple choices allowed.

Current Address (Street, City, State, Zip Code) *

Please provide your current address in the following format: Street Address, City, State, ZIP Code

Phone Number

Please provide a phone number that you can be contacted at. If you cannot provide a phone number or would prefer not to be contacted by phone, please provide an email address in the next section. The Health District needs at least one way to contact you should we wish to schedule an interview with you.

Email Address

Please provide an email address that you can be contacted at. If you cannot provide an email address or would prefer not to be contacted via email, please make sure that you have provided a phone number in the previous section. The Health District needs at least one way to contact you should we wish to schedule an interview with you.

If hired, can you furnish proof that you are eligible to work in the United States? *

Yes

Have you applied to the Health District before? If yes, when? *

Have you applied for a job with the Health District of Northern Larimer County before? If so, when did you apply?

Have you worked for the Health District before? If yes, when?

If you have previously held a job with the Health District of Northern Larimer County, please let us know when you worked with us.

Have you ever been convicted of any law violations? Include any plea of "guilty" or "no contest." Exclude minor traffic violations. *

Yes

If you mark 'Yes,' please provide details in the next section. NOTE: A conviction will not necessarily disqualify an applicant for employment.

If you answered YES, that you have been convicted of any law violations, please provide details. *

If you have not been convicted of any law violations, please write "N/A" or "Not applicable." NOTE: A conviction will not necessarily disqualify an applicant for employment.

If employed by the Health District, do you expect to be engaged in any additional business or employment outside of your job? *

Yes

If you answered YES, that you expect to be engaged in additional business if employed by the Health District, please provide details. *

Please provide a short description of the additional business you expect to be engaged in if employed by the Health District that includes an estimate of the amount of time devoted to each.

Education

In the section below, please list all relevant education applicable to each category. Compose each entry in the following format: School Name | Diploma, Degree, or Certificate Received | Name of Study or Field of Degree

High School or GED *

If you earned a GED in lieu of a high school diploma, just enter "GED."

College or University *

Please enter "N/A" or "Not applicable" if you have no college education. If you are currently enrolled in a program, include your anticipated graduation date next to your Name of Study/Field of Degree.

Vocational/Technical *

Please enter "N/A" or "Not applicable" if you have no vocational or technical education. If you are currently enrolled in a program, include your anticipated graduation date next to your Name of Study/Field of Degree.

Special Skills

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain. *

Do you speak more than one language? If yes, please list the languages and describe your proficiency in each. *

List professional, trade, business or civic activities and offices held. EXCLUDE labor organizations, political activities and any memberships that reveal race, religion, national origin, sex, age, sexual orientation, disability or other protected status. *

Work History

References

Have you worked under any other names? If yes, please list the name(s). *

Are you presently employed? If yes, may we contact your present employer? *

Yes, you may contact my present employer

You may contact my present employer ONLY if I become a finalist for this position and you notify me before doing so.

No, please do not contact my present employer, even if I become a finalist for this position.

I am not presently employed.

Have you ever been fired or asked to resign from a job? If YES, please explain the circumstances. *

Please provide 4 professional references (including past supervisors).

Reference Name (Full Name)

Reference's Current Role (Title, Organization)

Please provide your reference's current title and the organization they work for.

Reference's Email Address

Reference's Phone Number

Association to applicant

Organization where association developed

Reference Name (Full Name)

Reference's Current Role (Title, Organization)

Please provide your reference's current title and the organization they work for.

Reference's Email Address

Reference's Phone Number

Association to applicant

Organization where association developed

Reference Name (Full Name)

Reference's Current Role (Title, Organization)

Please provide your reference's current title and the organization they work for.

Reference's Email Address

Reference's Phone Number

Association to applicant

Organization where association developed

Reference Name (Full Name)

Reference's Current Role (Title, Organization)

Please provide your reference's current title and the organization they work for.

Reference's Email Address

Reference's Phone Number

Association to applicant

Organization where association developed

Upload Your Resume *

Upload a Cover Letter (Optional)

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Health District Job Application