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2. The City of Mountlake Terrace is an Equal Opportunity Employer
   It is policy of the City of Mountlake Terrace to fully comply with the Civil Rights Act of 1964, the Civil Rights Restoration Act of 1987, and related statutes and regulations in all its programs and activities.
   
   The City of Mountlake Terrace is an equal opportunity employer and encourages applications from all persons regardless of race, creed, color, sex, national origin, marital status, age or physical, sensory or mental disability unless based upon a bona fide occupational qualification. (State Law: Chapter 49.60 RCW and WAC 126)
4. Read All Instructions before Completing Application
   1. You must show that you meet the announced eligibility requirements as outlined in the job posting prior to hire.
   2. You must submit an original signed application for each position.
   3. A résumé may be attached but will not be accepted as a substitute for the application and any other required information.
   4. Lateral and entry level applicants please contact public safety testing.
   
   Improperly completed or unsigned applications will not be accepted.
6. Position/Examination Applying for:
8. Name
10. Address
12. City
13. State
14. Zip Code
16. Contact Phone
17. Email
19. Do you have a valid Drivers License?

    1. Yes

    1. No
23. Work Experience
    Describe in detail your work experience. Be sure to include your present job.
25. Employer #1
27. Name of Employer
28. Date Started - Date Left
    Date Started - Date Left Start Date

    —

    Date Started - Date Left End Date
30. Pay
32. Address
34. City
35. State
36. Zip Code
38. Supervisor Phone
39. May we contact them?

    1. Yes

    1. No
41. Reason for leaving:
43. List your job title and specific duties:
47. Employer #2
49. Name of Employer
50. Date Started - Date Left
    Date Started - Date Left Start Date

    —

    Date Started - Date Left End Date
52. Pay
54. Address
56. City
57. State
58. Zip Code
60. Supervisor Phone
61. May we contact them?

    1. Yes

    1. No
63. Reason for leaving:
65. List your job title and specific duties:
69. Employer #3
71. Name of Employer
72. Date Started - Date Left
    Date Started - Date Left Start Date

    —

    Date Started - Date Left End Date
74. Pay
76. Address
78. City
79. State
80. Zip Code
82. Supervisor Phone
83. May we contact them?

    1. Yes

    1. No
85. Reason for leaving:
87. List your job title and specific duties:
91. List Other Jobs You Have Held
93. Dates Worked
94. Job Title
95. Employer
107. Education, Training, and Certification
109. High School Diploma or G.E.D.:

     1. Yes

     1. No
111. College/University
112. Major/Concentration
113. Credit Hours*
114. Degree
121. *You may include credit hours that you will receive by the end of current quarter or semester.
     Proof of program accreditation and degree obtained is required prior to hire.
123. Other Courses and Training
124. Name of Institution & Location
125. Diploma/Hours Completed/Date
135. Professional License, Certificate, or Registration
     If required
136. License Number
137. Date Issued
     Date Issued
138. Expiration Date
     Expiration Date
147. A conviction record will not necessarily disqualify you for employment.
149. Have you been convicted of a felony within the last 10 years?

     1. Yes
     2. No
150. If yes, please describe:
154. Military Service/Veteran’s Preference
156. Do you wish to claim Veteran's Preference?

     1. Yes
     2. No
157. If you wish to claim Veteran’s Preference, you must attach a copy of your Form DD 214 that includes status of discharge.
161. Public Employment Information
163. Have you ever been employed by the City of Mountlake Terrace?

     1. Yes
     2. No
164. If yes, what was your position title?
166. Reason for leaving?

     1. Resigned
     2. Dismissal
     3. Lay Off
     4. Still Employed
170. Eligibility Requirements*
     Applicants are required to use this space to explain how they meet the eligibility requirements as outlined in the job posting. A résumé may be attached but will not be accepted as a substitute for completing this section.
172. Certificate of Applicant
     A. I understand that failure to show how I meet the eligibility requirements for this position may make me ineligible to compete in this examination process.
     B. I understand that drug testing is required for Public Safety positions prior to hire.
     C. I understand that background inquiries will be made and should investigation at any time disclose any misrepresentation or falsification, my application may be rejected, my name may be removed from the register, or I may be dismissed from City of Mountlake Terrace employment.
     D. I understand that I will be required to provide documentation showing my age, identity and my authorization to work in the United States.
     E. I hereby certify that all statements made on or in connection with this application including those regarding my training and experience are true and complete to the best of my knowledge and belief.
174. Signature of Applicant*
175. Date
     Date
179. Human Rights Data
     This information assists the City of Mountlake Terrace to identify recruitment needs. Although completion is optional, your cooperation would be greatly appreciated.
     
     The following information is being collected by the City of Mountlake Terrace Human Resources Department and Federal Equal Employment Opportunity requirements only. Your responses are strictly voluntary and will help in monitoring our affirmative action efforts. This page will be separated from your application prior to review by assessors.
181. Position Applied For:
183. Ethnic Category:

     1. Hispanic or Latino
     2. Caucasian
     3. African American

     1. Asian
     2. American Indian or Alaska Native
     3. Native Hawaiian or Other Pacific Islander

     Check any that apply.
185. Gender

     1. Male
     2. Female
187. Recruitment Information
189. How did you first learn about the position for which you are applying?

     1. Friend or Relative
     2. City Employee
     3. City Website
     4. Job Fair
     5. Newspaper Advertisement
     6. Other
191. Clarifications:
     If "City Employee," please list name.
     If you were directed to the city website, please provide the source.
     If "Job Fair," please name and/or date of job fair.
     If "Newspaper," please name newspaper.
     If "Other," please specify.
Leave This Blank:


193. 1. Receive an email copy of this form.
194. Email address

     This field is not part of the form submission.

195. Submit

* indicates a required field