Name: Alternative Services, Oregon Inc.
Address: 7165 SW Fir Loop, Ste 200, Tigard, OR, 97223-8055, US
Telephone: +1-503.941.5256
Price range: varies

Employment Experience
Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate any status protected by law against discrimination. Indicate if you have no previous work history.
Employer*
Job Title*
Supervisor
Telephone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Employed
From*
To
Hourly Rate/Salary
Work Performed*
Reason For Leaving*
Employer
Job Title
Supervisor
Telephone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Employed
From
To
Hourly Rate/Salary
Work Performed
Reason For Leaving
Employer
Job Title
Supervisor
Telephone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Employed
From
To
Hourly Rate/Salary
Work Performed
Reason For Leaving

Special Skills and Qualifications
Summarize special skills and qualifications acquired from employment or other experience
Are you a veteran of the U.S. Military service?
- Yes
- No
Which Branch?
Have you ever worked with developmentally disabled or mentally ill individuals?*
- Yes
- No
please identify type of program, location, and pertinent information
Indicate languages you can communicate in.
(Please include sign language and Braille, as well as foreign languages.)
Language
Understand
Speak
Read
Write
Language
Understand
Speak
Read
Write
Language
Understand
Speak
Read
Write
List professional, trade, business or civic activities and offices held.
(You may exclude those which indicate any status protected by law against discrimination.)
List name, relationship, and telephone number of at least three references that you are not related to and not personal friends with that can speak about you professionally
Name*
First Last
Relationship*
Phone*
Name*
First Last
Relationship*
Phone*
Name*
First Last
Relationship*
Phone*
Special Employment Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals with Physical or Mental Disabilities
Government contractors are subject to 38 USC 2012 of the Vietnam Era Veterans Readjustment Act of 1974, which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified disabled individuals.

If you are a disabled veteran, or have a physical or mental disability, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration for employment.
If you wish to be identified, please sign below
- Disabled Individual
- Disabled Veteran
- Vietnam Era Veteran

Education
High School*
Years Completed
Diploma*
- Yes
- No
Describe Course of Study
Describe specialized training, apprenticeship, skills and extra curricular activities
Honors received
College/University
Years Completed
Degree(s)
Describe Course of Study
Describe specialized training, apprenticeship, skills and extra curricular activities
Honors received
Graduate/Professional
Years Completed
Degree(s)
Describe Course of Study
Describe specialized training, apprenticeship, skills and extra curricular activities
Honors received

State any additional information you feel may be helpful to us in considering your application
Applicant’s Statement
I certify that answers given herein are true and complete to the best of my knowledge.

I authorize ASI to investigate all statements contained in this application for employment and to contact any and all parties as may be necessary in arriving at an employment decision. I hereby release and hold harmless ASI, its representatives, and anyone contacted during this investigation process from liability for any possible resulting damages. I understand that this application is not – and is not intended to be – a contract of employment.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge, no matter when such information is discovered. I understand, also, that I am required to abide by all rules and regulations of the company.
Write your first and last name to verify the above statement*
First Last
Date*

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Employment Experience

Special Skills and Qualifications

Education

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