Employment Application

List current licenses, registrations, or certificates relevant to the position for which you are applying.

All applicable licenses or certifications must be received in the Personnel Office prior to employment commencing. If hired, you remain responsible for ensuring that all applicable licenses remain in effect.

Include high school and/or institution issuing GED and any additional education/courses taken. Do not list dates of attendance for high school. List most recent first.

List all work experience, whether or not relevant to this position, and all relevant volunteer experience, most recent to be listed first.

These should be people in a position to discuss your qualifications for the position you seek. Include especially managers, directors, or heads of departments under whom you have worked. Indicate any who are related to you. Southwest Health and Human Services reserves the right to contact all prior employers, educational institutions or institutions where you have volunteered in addition to references listed below

Proof of applicable military status/eligibility, such as a DD214 form, will be required in order to claim credits. Please attach DD214 form or forward it within five (5) business days.

Please read carefully (voluntary disclosure): As an affirmative action employer, we must monitor our equal employment opportunity and affirmative action program, and report these results to government agencies. If you choose not to provide some or all of this information, you will not be subject to any negative or adverse treatment. The information you provide is completely voluntary and will only be used to monitor our compliance with equal opportunity laws and regulations.

I certify that the answers I have given on this application are true and correct to the best of my knowledge. I understand that any false or misleading information provided, or any omission or concealment of facts, will disqualify me from consideration for employment, and constitutes grounds for my immediate dismissal should I be employed by Southwest Health and Human Services.

I understand, acknowledge, and agree that no offer of employment is valid or binding until formal approval by the Southwest Health and Human Services Board or the appointing authority referenced in the job description and that until such approval that Southwest Health and Human Services shall not be liable for any reliance on any oral or written offers of employment made to me.

In connection with this application I hereby authorize any and all current and former employers, organizations where I have volunteered (“volunteer organizations”) and references named in this application, or any agent of such a former employer or volunteer organizations, to release to Southwest Health and Human Services and its agents any and all information regarding my job performance and fitness/qualifications to perform the position I am presently seeking and any other employment or related information, both public and private, in their possession. I understand that Southwest Health and Human Services will use this information to determine my fitness/qualifications for this position I am seeking. This authorization expires one year from the date of my signature, below.

I hereby release Southwest Health and Human Services and all former employers, volunteer organizations, and references listed herein and any and all agents acting on behalf of said Southwest Health and Human Services, former employers, volunteer organizations or references, for any and all liability of whatever nature by reason of requesting or providing such information.

Upload your PDF resume and cover letter below. For security reasons, only PDF documents will be accepted for upload. Alternatively, email your cover letter and resume to: hr@swmhhs.com.