Fillable Printable Manual Fill-In ODFW Application - Oregon Department of Fish and Wildlife
Fillable Printable Manual Fill-In ODFW Application - Oregon Department of Fish and Wildlife
Manual Fill-In ODFW Application - Oregon Department of Fish and Wildlife
“To protect and enhance Oregon's fish and wildlife and their habitats for use and enjoyment by present and future generations”
OregonDepartmentofFishandWildlife
EmploymentApplicationForm
Revised February 201 2
GENERAL INSTRUCTIONS
Your application materi als (including any required skill code suppl ements, test answers, colle ge transcripts, etc.) must be
received by the recruiting agency (at the address listed in the job posting by the date and ti me stated).
1. If you are a current state employee please provide
your Employee Identification Number (OR#). The
Oregon Department of Fish and Wildlife will use it for
recruitment identification and trackin g as authorized by
OAR 105-040-0001. If you are hired, your so cial security
number will be used for employee records, payroll, and
insurance p urposes pursuant to OAR 105-040-
0001(1 )(b)(A).
2. Complete a separate application for each job you
apply for unless the job posting gives different
instructions. Legible photocopies a re acceptable.
3. Signature:
a. By electronically submitting your application, you
agree to the conditions stated in the certification
and signature section of the application, which is
enforceable as if you had si gned.
b. If submitting in hard copy format, type or print
clearly in dark ink and sign your application in
ink.
4. Submit only the application materials requested o n
the job posting. Do not include work examples or
these instructions with y our application materials.
5. Need to list more than 10 jobs? Copy a “Work
Experience” page and number added jobs 1 1, 12, etc.
6. Incomplete or illegible applications (including faxed
applications) will not be accepted. The Oreg on
Department of Fish and Wildlife is not responsible for
applications that are misdirected, lo st in the mail, or lost
as a result of transmitting by fax or email.
Please keep a copy of your application materials.
Copies will not be provided.
VETERANS’ PREFERENCE
Applicants ar e eligible to use veterans’ prefe ren ce when applying with the Oregon Department of Fish and Wildlife in
accordance with ORS 408.225, 408.230, and 408.235; OAR 105 -040-0010 and 105-040-00 15.
5 points (Veteran):
To receive 5 points you must have served on active duty in
the Armed Forces of the United States (US):
1. For more than 90 consecutive days begi nning on or
before January 31, 1955; or
2. For more than 178 con se c utive days; or
3. For 178 days or less and has a disability rating from the
US Dept. of Veteran’s Affairs; or
4. For at least one day in a combat zone; or
5. Received a combat or campaign ribbon or an
expeditionary medal for service in the Armed Forces.
To qualify under 1 - 5 above you must have been
discharged or released under honorable conditions; or
6. Is receiving a non-service connected pension from the
US Dept. of Veteran’s Affairs
To receive credit as a 5 Point Veteran you must attach
to your application: (Please redact your SSN from
documents)
A copy of your DD214/DD215 form; or
A letter from the US Dept. of Veteran’s Affairs indi cating
you receive a non-service connected pe nsion.
10 points (Di sabled Veteran):
To receive 10 points you must be:
1. A person whose discharge or release from active duty
was for a disability incurred or aggravated in the line of
duty; or
2. Entitled to disability compensation under laws
administered by the United States Department of
Veterans Affairs; or
3. Awarded the Purple Heart for wounds received in
combat.
To receive credit as a 10 Point Veteran you must attach
to your application: (Please redact your SSN from
documents)
A copy of your DD214/DD2 15 form; and
A copy of your veterans’ disability preference letter from the
Department of Veterans’ Affairs.
For additional information on Veterans’ Preference eligibility, including definition of the terms “veteran ” and “disabled
veteran,” cont act the Oregon Department of Veterans’ Affairs at 1-800-692 -9666.
WORK EXPERIENCE INSTRUCTIONS
The information you provide in the “Work Experience” section will be used to evaluate your experience. Starting with your
current or most recent job, list all your jobs (paid or volunteer) for the last ten years. You may wish to include related
experience gained mo re than 10 years ago, if it helps your suitability for the job. A resume or position description will not
substitute for completion of the “Work Experience” section.
1. Critical: If you held more than one position within the
same compa ny, list each position as a separa te jo b
(including job rotations or work-out-of-cl ass) in the
“Work Experience” section. Provide your duties as well
as beginning and ending d ates and hours worked per
week for each positio n.
2. Critical: Clea rly describe all your duties. If your
description of work in the “Work Experie nce” section i s
too brief and/or insufficient to determine the work
performed or your level, your application may not be
considered.
3. Critical: Credit for work that is less than full-time is
pro-rated based on a 40-hour week. If you worked
more than 40 hours a week, you will be given credit for
40 hours.
4. Critical: If your hours vary, indicate the average
number of hours worked per week. Do not give a range
of time such as. “20-30 hours” or “varies.” No credit will
be given for jobs when hours worked are not specific.
5. Critical: If related dutie s were not the main focus of the
job, prov ide the percentage of time you spent doing
the duties that are relate d to the job posting.
6. Examples: Bookke eping 4 hours out of a 40 hour week
= 10%; or 5 hours out of a 20 hour week = 25%.
7. Critical: To receive credit for experienc e mentioned in
any supplemental questions, the experience must be
listed in the “Work Experience” section of your
application.
OREGONDEPARTMENTOFFISHANDWILDLIFEEMPLOYMENTAPPLICATION
An Equal Opportunity Employer
TYPE or PRINT in INK
Please complete the application by typing or clearly printing in dark ink. Submit a separate application (photocopy
acceptable) for each job posting.
JOB APPLIED FOR (Listed on the job posting):
CLASSIFIC ATION NUM BER: JOB POSTING NUMBER (if applicable):
OREGON EMPLOYEE IDENTIFICATION NUMBER: LOCATION
(
S
)
OF JOB APPLYING FO R:
(Current and former employees only )
OR
NAME AND ADDRESS
NAME (LAST, FIRST, M.I.): HOME PHONE (include area code):
MAILI NG ADDRESS: WORK PHONE (Provide only one including area code):
CITY STATE ZIP CODE: CELL PHONE
EMAIL ADDRESS
:
PRESENT EMPLOYER LAST EMPLOYER (Check one): May We Contact?
CITY AND STATE:
Yes No
VETERANS’ PREFERENCE - To Receive Credit Attach a Co py of Your DD214/DD215
POINTS
(
Check One
)
: DATE OF ENTRY
(
M-D-Y
)
: DATE OF DISCHARGE
(
M-D-Y
)
: BRANCH OF SERVICE:
5 10
WORK SCHEDULE AVAILABILITY
Check Onl
y
One: Check Onl
y
One: Date You Can Re
p
ort For Work:
PERMANENT (P)
SEASONAL (S) EITHER (B)
FULL TIME (F) FULL OR PART TIME (E) JOB SHARE (J)
PART TIME (P) INTERMITTENT (I) ANY (B)
Are you also willing to work for the State of Oregon in a temporary position? (Check one) YES NO
Do you have a driver license? YES NO Driver license state:
Legal right to work in the United States? YES NO
LICENSE / REGISTRATION / CERTIFICATE
List any licenses, registrations and certificates you currently hold that are pertinent to the position(s) for
which you are applying (boater certifica tion, first aid, CPR, Oregon Commercial Driver Licen s e (CDL), etc.)
Descri
p
tion State Numbe
r
Ex
p
iration
SPECIALIZED SKILLS AND KNOWLEDGE
List skills or knowledge th at show your ability to perform the job for which you are applying (such as types of
surveys conducted, boats operated, computer languages or software programs used, etc.).
A
ttach additional pages
if needed.
OFFICE USE ONLY
SKILLS
D
D
A
A
T
T
E
E
S
S
T
T
A
A
M
M
P
P
ACCEPTED
NOT ACCEPTED _________ ______
(Reason Code)
REVIEWER’S INITIALS / DATE:
Test Date: Expiration Date:
TEST
SCORE
VET PTS FINAL
1 2 3 4 5 6
EDUCATION / TRAINING HIST ORY
List colleges, military, trade, business or other schools attended.
Do you have a high school diploma or a GED certificate? (Check one) YES NO
Name and Location
Of
School, College, or University
Course of Study
(List Major)
Credits Earned
Check One
&
Indicate Hours
Did You
Graduate?
(Yes / No)
Degree/
Certificate
Received
(AA, BA, BS,
MA, PhD)
Start
Mo/Yr to
End
Mo/Yr
A
Quarter Semester Clock
B
Quarter Semester Clock
C
Quarter Semester Clock
W O R K E X P E R I E N C E
JOB NUMBER 1 (current or most recent position)
NAME OF EMPLOYER
EMPLOYER’S ADDRESS and PHONE NUMBER
YOUR JOB TITLE SUPERVISOR’S NAME and PHONE NUMBER
MONTHLY SALARY
SUPERVISION / LEADWORK CHECK AREAS YOU WERE RESPONSIBLE FOR:
Assigning and Reviewing work Handling Disciplinary problems
Rating Work Performance Responding to Grievances
Hiring or Recommending Hiring Not Responsible for Any of Above
If you checked any of these boxes, list the number of employees and their job titles:
FROM
(
MONTH - YEA R
)
TO
(
MONTH - YEAR
)
TOTAL TIME IN CURRENT
OR LAST POSITION
:
HOURS WORKED PER
WEEK (Average
)
DUTIES (List all duties you performed. No credit will be given if this section is not completed.):
Reason for leaving this position:
CONTINUE WORK EXPERIENCE ON NEXT PAGE PAGE 2
W O R K E X P E R I E N C E
JOB NUMBER 2
NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER
YOUR JOB TITLE SUPERVISOR’S NAME and PHONE NUMBER
MONTHLY SALARY SUPERVISION / LEADWORK CHECK AREAS YOU WERE RESPONSIBLE FOR:
Assigning and Reviewing work Handling Disciplinary problems
Rating Work Performance Responding to Grievances
Hiring or Recommending Hiring Not Responsible for Any of Above
If you checked any of these boxes, list the number of employees and their job titles:
FROM
(
MONTH - YEA R
)
TO
(
MONTH - YEAR
)
TOTAL TIME IN POSITION: HOURS WORKED PER
WEEK (Average)
DUTIES (List all duties you performed. No credit will be given if this section is not completed.):
Reason for leaving this position:
JOB NUMBER 3
NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER
YOUR JOB TITLE SUPERVISOR’S NAME and PHONE NUMBER
MONTHLY SALARY SUPERVISION / LEADWORK CHECK AREAS YOU WERE RESPONSIBLE FOR:
Assigning and Reviewing work Handling Disciplinary problems
Rating Work Performance Responding to Grievances
Hiring or Recommending Hiring Not Responsible for Any of Above
If you checked any of these boxes, list the number of employees and their job titles:
FROM
(
MONTH - YEA R
)
TO
(
MONTH - YEAR
)
TOTAL TIME IN POSITION: HOURS WORKED PER
WEEK (Average)
DUTIES (List all duties you performed. No credit will be given if this section is not completed.):
Reason for leaving this position:
CONTINUE WORK EXPERIENCE ON NEXT PAGE
PAGE 3
W O R K E X P E R I E N C E
JOB NUMBER 4
NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER
YOUR JOB TITLE SUPERVISOR’S NAME and PHONE NUMBER
MONTHLY SALARY SUPERVISION / LEADWORK CHECK AREAS YOU WERE RESPONSIBLE FOR:
Assigning and Reviewing work Handling Disciplinary problems
Rating Work Performance Responding to Grievances
Hiring or Recommending Hiring Not Responsible for Any of Above
If you checked any of these boxes, list the number of employees and their job titles:
FROM
(
MONTH - YEA R
)
TO
(
MONTH - YEAR
)
TOTAL TIME IN POSITION: HOURS WORKED PER
WEEK (Average)
DUTIES (List all duties you performed. No credit will be given if this section is not completed.):
Reason for leaving this position:
JOB NUMBER 5
NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER
YOUR JOB TITLE SUPERVISOR’S NAME and PHONE NUMBER
MONTHLY SALARY SUPERVISION / LEADWORK CHECK AREAS YOU WERE RESPONSIBLE FOR:
Assigning and Reviewing work Handling Disciplinary problems
Rating Work Performance Responding to Grievances
Hiring or Recommending Hiring Not Responsible for Any of Above
If you checked any of these boxes, list the number of employees and their job titles:
FROM
(
MONTH - YEA R
)
TO
(
MONTH - YEAR
)
TOTAL TIME IN POSITION: HOURS WORKED PER
WEEK (Average)
DUTIES (List all duties you performed. No credit will be given if this section is not completed.):
Reason for leaving this position:
CONTINUE WORK EXPERIENCE ON NEXT PAGE
PAGE 4
W O R K E X P E R I E N C E
JOB NUMBER 6
NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER
YOUR JOB TITLE SUPERVISOR’S NAME and PHONE NUMBER
MONTHLY SALARY SUPERVISION / LEADWORK CHECK AREAS YOU WERE RESPONSIBLE FOR:
Assigning and Reviewing work Handling Disciplinary problems
Rating Work Performance Responding to Grievances
Hiring or Recommending Hiring Not Responsible for Any of Above
If you checked any of these boxes, list the number of employees and their job titles:
FROM
(
MONTH - YEA R
)
TO
(
MONTH - YEAR
)
TOTAL TIME IN POSITION: HOURS WORKED PER
WEEK (Average)
DUTIES (List all duties you performed. No credit will be given if this section is not completed.):
Reason for leaving this position:
JOB NUMBER 7
NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER
YOUR JOB TITLE SUPERVISOR’S NAME and PHONE NUMBER
MONTHLY SALARY SUPERVISION / LEADWORK CHECK AREAS YOU WERE RESPONSIBLE FOR:
Assigning and Reviewing work Handling Disciplinary problems
Rating Work Performance Responding to Grievances
Hiring or Recommending Hiring Not Responsible for Any of Above
If you checked any of these boxes, list the number of employees and their job titles:
FROM
(
MONTH - YEA R
)
TO
(
MONTH - YEAR
)
TOTAL TIME IN POSITION: HOURS WORKED PER
WEEK (Average)
DUTIES (List all duties you performed. No credit will be given if this section is not completed.):
Reason for leaving this position:
CONTINUE WORK EXPERIENCE ON NEXT PAGE
PAGE 5
W O R K E X P E R I E N C E
JOB NUMBER 8
NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER
YOUR JOB TITLE SUPERVISOR’S NAME and PHONE NUMBER
MONTHLY SALARY SUPERVISION / LEADWORK CHECK AREAS YOU WERE RESPONSIBLE FOR:
Assigning and Reviewing work Handling Disciplinary problems
Rating Work Performance Responding to Grievances
Hiring or Recommending Hiring Not Responsible for Any of Above
If you checked any of these boxes, list the number of employees and their job titles:
FROM
(
MONTH - YEA R
)
TO
(
MONTH - YEAR
)
TOTAL TIME IN POSITION: HOURS WORKED PER
WEEK (Average)
DUTIES (List all duties you performed. No credit will be given if this section is not completed.):
Reason for leaving this position:
JOB NUMBER 9
NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER
YOUR JOB TITLE SUPERVISOR’S NAME and PHONE NUMBER
MONTHLY SALARY SUPERVISION / LEADWORK CHECK AREAS YOU WERE RESPONSIBLE FOR:
Assigning and Reviewing work Handling Disciplinary problems
Rating Work Performance Responding to Grievances
Hiring or Recommending Hiring Not Responsible for Any of Above
If you checked any of these boxes, list the number of employees and their job titles:
FROM
(
MONTH - YEA R
)
TO
(
MONTH - YEAR
)
TOTAL TIME IN POSITION: HOURS WORKED PER
WEEK (Average)
DUTIES (List all duties you performed. No credit will be given if this section is not completed.):
Reason for leaving this position:
CONTINUE WORK EXPERIENCE ON NEXT PAGE
PAGE 6
W O R K E X P E R I E N C E
JOB NUMBER 10
NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER
YOUR JOB TITLE SUPERVISOR’S NAME and PHONE NUMBER
MONTHLY SALARY SUPERVISION / LEADWORK CHECK AREAS YOU WERE RESPONSIBLE FOR:
Assigning and Reviewing work Handling Disciplinary problems
Rating Work Performance Responding to Grievances
Hiring or Recommending Hiring Not Responsible for Any of Above
If you checked any of these boxes, list the number of employees and their job titles:
FROM
(
MONTH - YEA R
)
TO
(
MONTH - YEAR
)
TOTAL TIME IN POSITION: HOURS WORKED PER
WEEK (Average)
DUTIES (List all duties you performed. No credit will be given if this section is not completed.):
Reason for leaving this position:
CERTIFICATION AND SIGNATURE
I understand that any verba l or written statement that is false, fraudulent or misleading that is contained in this application
or attached materials, or made in the course of any related employment pro ce ss, whether made by me or by others at my
request, will result in rejection of my application, denial of employment, or dismissal from state service if discovered afte r
employment, and under some circumstances, may result in prosecution for a crim e.
I certify that all statements contained h erein are true a nd complete whether made by me or others at my reque st.
I understand that if hired, I must prove that I am legally authorized to work in the United States.
I authorize the Oregon Department of Fish and Wildlife to check employment reference s and verify education
information provided on this employm ent application and as disclosed in the interview process.
I authorize the Oregon Department of Fish and Wildlife to check my driving re cord if the position for whi ch I am
applying requires driving.
I understand I may be aske d to submit to a pre-employment drug test and/or criminal histo ry ba ckground check as a
condition of employment.
I release the Oregon Dep artment of Fish and Wildlife and all provid ers of information from any liability as a result of
furnishing and receiving a ny information related to the Oregon Department of Fish and Wildlife’s hiring process.
By electronically submitting my application materials, I agree to the conditions stated in this “Certification and Signature”
section, and t his section is enforceable as if I had signed below.
SIGNATURE (Must signed IN INK if submitting hard copy):
DATE:
KEEP A COPY OF YOUR APPLICATION FOR INTERVI EWS. COPIES WILL NOT BE PROVIDED.
Your application materi als, responses to su pplemental questio ns, college transcripts, etc.) must be received at the
address listed on the job posting by the close date or it may not be accepted.
THANK YOU FOR YOUR INTEREST IN EMPLOYMENT WITH ODFW
2/2012
