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APPLICATIONPlease complete all sections
Disability Rights Oregon Work Incentives Planning & Assistance (WIPA) Intake Specialist
Please submit a letter of interest, a copy of your resume, and a completed application form (available at http://www.droregon.org/about-us/employment). Interviews will begin as resumes are received and qualified candidates are identified. Applications must be received by email at: [email protected]. If you need to submit your application in an alternative format, please contact us at [email protected] or (503) 243-2081.
A. Personal InformationName
Address
Telephone/Email
B. Education/TrainingYears of School Completed
Degrees EarnedSchool Attended & Years Obtained
Other Relevant Training
Relevant Volunteer Activities
C. Work History (Please indicate current position first and then previous positions)Employer #1Employer & Address/Phone
Dates of Employment
Position
Reason for Leaving
Primary Responsibilities
May We Contact Yes No
Employer #2Employer & Address/Phone
Dates of Employment
Position
Reason for Leaving
Primary Responsibilities
May We Contact Yes NoEmployer #3
Employer & Address/Phone
Dates of Employment
Position
Reason for Leaving
Primary Responsibilities
May We Contact Yes No
Employer #4Employer & Address/Phone
Dates of Employment
Position
Reason for Leaving
Primary Responsibilities
May We Contact Yes No
Please add separate sheets for additional employers.
D. Please use a check box below to tell us your level of expertise in each of the following software programs and technologies. Add additional as needed. Note: be honest: we don’t expect you to be an expert on everything!
Name of software/technology Level of ExpertiseNone Basic Average Advanced
Microsoft WordMicrosoft ExcelMicrosoft PowerPointMicrosoft OutlookGmailGoogle DriveGoogle CalendarAdobe AcrobatSkype or other virtual meeting program, please specify: Database, please specify: Multi-line phone systemsMulti-function copiersTroubleshooting PC’s
E. Do you possess any special skills which would be considered valuable in this job? (e.g. medical, education or social service training).
F. Is there anything else you would like us to consider in reviewing your application?
G. References
Please list 3 professional references (supervisors preferred):Name Relationship
# of YearsEmail Address, Mailing Address
and Phone Number
NOTICE: If you are selected for this position, you will be required to successfully complete a comprehensive federal background check from the Social Security Administration.
Declaration
I declare that the information contained in this application is complete and true. Falsifying any information on this application can be considered grounds for rejection of the application or dismissal if employed.
Signature Date