Apply for Department Administrative Liaison

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Summary
Title:Department Administrative Liaison
ID:20279
Job Status:Full Time
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Application Information
* Source:
If Employee Referral, Who?:
Attachments
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Cover Letter:
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Application for Employment 2024
Personal Information
* Have you ever applied for employment with us before?
Yes   No
* Have you ever worked for SEIU HCII?
Yes   No
* What is your salary expectation?
* How did you hear about us? If referred, please provide employee’s name.
Please list the names of any relatives working for SEIU:
* When would you be available to begin work?
List Other special training or skills (professional licenses, certificates, languages, computers, etc.):

EDUCATION & TRAINING
Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name and Location of School Course of Study Years Completed Did you Graduate? Degree & Major
Graduate
Yes   No
College
Yes   No
Business
Trade
Technical
Yes   No
High School
Yes   No
Elementary
Yes   No

EMPLOYMENT HISTORY
Give your full employment record, starting with your current or most recent employment

EMPLOYER 1

Employer Name & Address Employer Phone Dates Employed

Job Title Supervisor Name & Title

May we Contact? Responsibilities Reason for Leaving
Yes   No

Employer 2

Employer Name & Address Employer Phone Dates Employed

Job Title Supervisor Name & Title

May we Contact? Responsibilities Reason for Leaving
Yes   No

Employer 3

Employer Name & Address Employer Phone Dates Employed

Job Title Supervisor Name & Title

May we Contact? Responsibilities Reason for Leaving
Yes   No

REFERENCES Please provide three references (not relatives).

Name Title Company Address Phone

MILITARY INFORMATION
* Did you serve in the U.S. Armed Forces?
Yes   No
If yes, what branch?
Describe any training received relevant to the position for which you are applying:

OTHER INFORMATION
* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment.)
Yes   No
* Are you at least 18 years or older?
Yes   No
* Do you know of any reason why you cannot perform the essential functions of the job for which you are applying with or without reasonable accommodation??
Yes   No

AUTHORIZATION
I certify that the information provided in this employment application (and accompanying resume, if any) is true and complete, and I understand that any false information or significant omissions may be justification for my dismissal from employment, if discovered at a later date.

I authorize investigation of all statements contained in this application (and accompanying resume, if any). I also authorize the Union to contact my present employer (unless otherwise noted in this application form), past employers, and listed references.

I authorize any person, school, current or previous employer, and organization named in this application form(and accompanying resume, if any) to provide the Union with relevant information and opinion that may be useful to the Union in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements.

* Signature (type name):
* Date:
Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The Information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Individual with a Disability
An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred - a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5,1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

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