Washington State

Employment Application

Most state job opportunities are posted and applied for on careers.wa.gov. Follow the instructions located on the job posting and submit completed application directly to the hiring agency. If a Supplemental Questionnaire is included on the job posting, complete questionnaire and attach.

The State of Washington is an equal opportunity employer. Persons with a disability, who need assistance with their application in an alternative format, call (360) 664-1960 or 1-877-664-1960. TTY users should first call 711 to access the Washington Relay Service.

General Information – Review all questions carefully before preparing your application.
Position (Job Title) and Agency	Job Number
Name (Last, First, and Middle Initial)	Email
Mailing Address	City, State, ZIP
Home Phone (Include area code)	Work Phone (Include area code)	Cell or Message Phone (Include area code)
Promotional Information
Do you currently hold permanent status as a classified employee within the Washington General Service or Washington Management Service? Yes No If yes, provide the following: Personnel Number: Agency Permanently Employed:
Employment Preferences – Check all types and shifts you will accept.
Type: Full-Time Part-Time Project Non-Permanent (temporary) Seasonal Internship Shift: Day Evening Night Rotating Weekends On-Call
Education and Training
Have you graduated from high school or passed the GED? Yes No List college, business school, military training, and other relevant education.
School Name and Location	Month and Year Attended From and To	Credits Earned	Major	Type of Degree Awarded	Year Degree Received
Quarter	Semester	Other
1.	/
2.	/
3.	/

Employment History – This section must be completed. You may use this form for both volunteer and paid experience. *For volunteer work, 174.3 hours equals one month of experience. If you need more spaces, see the next page.
1. Present or Last Employer	Employer’s Address	Employer’s Phone (Include area code)
Your Title	Dates of Employment From / To /	Total Months	Average Hours /Week
Immediate Supervisor’s Name	Reason for Leaving	Volunteer Hrs*	Number of Employees Supervised
Duties:
2. Previous Employer	Employer’s Address	Employer’s Phone (Include area code)
Your Title	Dates of Employment From / To /	Total Months	Average Hours /Week
Immediate Supervisor’s Name	Reason for Leaving	Volunteer Hrs*	Number of Employees Supervised
Duties:
3. Previous Employer	Employer’s Address	Employer’s Phone (Include area code)
Your Title	Dates of Employment From / To /	Total Months	Average Hours /Week
Immediate Supervisor’s Name	Reason for Leaving	Volunteer Hrs*	Number of Employees Supervised
Duties:
4. Previous Employer	Employer’s Address	Employer’s Phone (Include area code)
Your Title	Dates of Employment From / To /	Total Months	Average Hours /Week
Immediate Supervisor’s Name	Reason for Leaving	Volunteer Hrs*	Number of Employees Supervised
Duties:
5. Previous Employer	Employer’s Address	Employer’s Phone (Include area code)
Your Title	Dates of Employment From / To /	Total Months	Average Hours /Week
Immediate Supervisor’s Name	Reason for Leaving	Volunteer Hrs*	Number of Employees Supervised
Duties:
6. Previous Employer	Employer’s Address	Employer’s Phone (Include area code)
Your Title	Dates of Employment From / To /	Total Months	Average Hours /Week
Immediate Supervisor’s Name	Reason for Leaving	Volunteer Hrs*	Number of Employees Supervised
Duties:
7. Previous Employer	Employer’s Address	Employer’s Phone (Include area code)
Your Title	Dates of Employment From / To /	Total Months	Average Hours /Week
Immediate Supervisor’s Name	Reason for Leaving	Volunteer Hrs*	Number of Employees Supervised
Duties:
8. Previous Employer	Employer’s Address	Employer’s Phone (Include area code)
Your Title	Dates of Employment From / To /	Total Months	Average Hours /Week
Immediate Supervisor’s Name	Reason for Leaving	Volunteer Hrs*	Number of Employees Supervised
Duties:

Date and Signature – All answers and statements are true and complete to the best of my knowledge. I understand that the state may verify information, and that untruthful or misleading answers are cause for rejection of this application or dismissal if employed. Electronic applications do not require a signature; you may type in the date and your first and last name.
Date	Signature

Supplemental Profile Data

Government agencies require periodic reports about the state workforce for equal opportunity and affirmative action efforts. Providing such information about yourself is voluntary and your response will be used only in accordance with Washington State’s equal opportunity and affirmative action efforts. For more information view the Affirmative Action Definitions.

Submit completed form directly to the hiring agency.

Name (Last, First, Middle Initial)	Job Number
Male Female X	Are you a person with a disability? Yes No	Are you 40 years or older? Yes No
What race or culture do you consider yourself? If you consider yourself two or more races, select all that apply. American Indian or Alaskan Native Hispanic or Latino Asian Native Hawaiian or other Pacific Islander Black or African American White or Caucasian
Veterans Information – Employment preference is given to veterans who meet state qualifications, their spouses or registered domestic partner. Note: To qualify and receive veteran’s preference, you may be asked to provide a copy of your record of discharge, DD214 or NGB Form 22 or alternate verification of military service with your application.
Are you a US Veteran? Yes No Are you a Vietnam Era Veteran? Yes No Are you entitled to compensation under laws administered by the US Department of Veterans Affairs (USDVA) for disability? Yes, I have a service disability rated at 30 percent or more. Yes, I have a service disability rated at 10 or 20 percent as determined by the USDVA which has resulted in a serious employment handicap and I can provide a letter from the USDVA confirming this status. Yes, I was discharged or released from active duty for a disability incurred or aggravated in the line of duty. No, I am not entitled to compensation as stated. Are you the spouse or registered domestic partner of an honorably discharged deceased veteran, OR are you the spouse or registered domestic partner of an honorably discharged 100% service disability veteran? Yes No Did you serve during a period of war or a military campaign for which a campaign ribbon shall have been awarded? Yes No Are you currently employed in permanent or permanent project positions in a state agency? Yes No If yes, were you called to active duty from employment with the state for at least 180 days? Yes No If yes, Dates to and Type of Discharge: .