nurse and elderly lady

Application For Employment

We consider applicants for all positions without regard to race, color, national origin, sex, religion, retaliation, association with protected class, prohibition on genetic screening and brain-wave testing, age, marital or veteran status, physical or mental disability, or any other legally protected status.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

All persons hired will be required to submit and pass with approval a criminal background check.

Personal Information

If you are under 18-years-old, can you provide required proof of your eligibility to work?

Have you ever filed an application or been employed with any of the following District entities before?

Clatsop Care and Rehabilitation Center


Clatsop Care Retirement Village


Clatsop Care Memory Community


Clatsop In Home Care


Clatsop Care Health District


Are you currently employed?

May we contact your current employer?

What date would you be able to begin work?

Are you seeking full-time or part-time employment?

Have you been charged or convicted of abuse of any type?

Do you have any restrictions on days or hours that you are unable to work?

Please describe the days or hours that you are unable to work.

Are you physically or otherwise able to perform the job duties for the position you are applying?

Can you travel if a job requires it?


School Name City/State Years Completed Major/Degree
High School

Professional References

Please list 3 professional references (no relatives or friends), contact information, your relationship to the individual, and the length of time you've known one another.

Employment Experience

Please start with your most recent employer.

loaderThank you. We will get back to you as soon as possible.