PLEASE NOTE: All sections marked with * are required.You may mark sections not applicable to you with N/A. A confirmation screen will pop up when you have successfully submitted your application. If you hit the SUBMIT button and do not see this screen, please review your application for any missing required fields, complete them, and hit SUBMIT again.Today's Date* MM slash DD slash YYYY Position Title* Please fill in the position title you are applying for as shown on the job announcement.Personal InformationName* First MI Last Current Address* Street Address Address Line 2 City State / Province ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Primary Phone*Secondary PhoneEmail* Are you eligible to work in the U.S.?* Yes No Placement InformationHave you previously been employed at Solid Ground?* Yes No Previous Employment Position at Solid Ground*Position Dates of Previous Solid Ground Employment* Employment/Work ExperienceComplete this portion even if attaching your résumé. Describe your work history over the last 10 years if applicable. List your current/most recent employer first. Position 1Employer Name* Supervisor Name* Phone NumberMay we contact?* Yes No Employment Dates* Position Held* Description of Duties*Reason for Leaving*Position 2Employer Name Supervisor Name Phone NumberMay we contact? Yes No Employment Dates Position Held Description of DutiesReason for LeavingPosition 3Employer Name Supervisor Name Phone NumberMay we contact? Yes No Employment Dates Position Held Description of DutiesReason for LeavingEmployment GapsPlease identify and explain gaps in employment greater than 3 months.Dates Reason for unemployment Dates Reason for unemployment Education HistoryApplicants may be asked to provide a copy of diploma, GED, certificates or transcripts.High School* City, State* Degree/Certificate*DiplomaGEDIn processOtherTotal Years Completed* Name of Certificate or Degree* College/University/Institution* City, State* Degree/Certificate*DegreeCertificateIn processOtherTotal Years Completed* Name of Degree or Certificate* College/University/Institution City, State Degree/CertificateDegreeCertificateIn processOtherTotal Years Completed Name of Degree or Certificate College/University/Institution City, State Degree/CertificateDegreeCertificateIn processOtherTotal Years Completed Name of Degree or Certificate Required Supplemental QuestionsRelevant Experience*Describe your experience working with people from a variety of racial, cultural and economic backgrounds. Relevant Education*Describe how your education and experience qualifies you for this position. Qualifications Statement*Based on the qualifications as listed in the job description, please state how you meet each of the qualifications required for the job. Applicant Data SupplementWe ask your assistance in completing this form so Solid Ground's Human Resources Department may track various data. The information requested is voluntary; you are not required to provide it. This form will be removed from your application packet by the HR department prior to distribution for screening and selection. Thank you for your assistance. Name Position You're Applying For Sex Female Male Ethnic/Racial BackgroundIf you are a person with a multi-racial or multi-cultural background, please check all appropriate boxes. Black or African American Asian Native Hawaiian or Pacific Islander Hispanic or Latino Caucasian American Indian or Alaska Native Two or More Races Other Please enter ethnic/racial background Are you living with a disability? Yes No Do you have the ability, with or without reasonable accommodation, to perform the essential function of the position for which you are applying? Yes No If "no," please explain:Are you a veteran? Yes No How did you learn about this employment opportunity? Friend or Relative Solid Ground Employee Solid Ground Website Job Fair Online Job Board Social Media Other Friend or relative name Solid Ground employee name Name and/or date of job fair Which job board? Craigslist DiversityJobs Idealist LinkedIn Indeed College/University Job Board UW School of Social Work Distribution list Which social media? Facebook Linkedin Please specify Do you have relative(s) and or friend(s) employed by Solid Ground?If yes, please specify:Name Relationship Job Title Location Required DocumentsPlease upload your résumé to complete your application before submitting.Certification of Application*By checking yes below, I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation into all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not, and is not intended to be, a contract of employment. I understand that supplementary information may be required dependent upon the position for which the application is made. In the event of employment, I understand that false or misleading information given by me in my application or interviews will result in discharge. Check box below: Yes Cover Letter*Please upload a Word document or PDF.Max. file size: 100 MB.Résumé*Please upload a Word Document or PDF:Accepted file types: pdf, docx, doc, Max. file size: 3 MB.Name & Date of Certification* Δ