6651 SW Capitol Highway

Portland, OR 97219
503.244.0111
www.oregonjcc.org

Employment Application
EQUAL EMPLOYMENT OPPORTUNITY: The Mittleman Jewish Community Center (MJCC) is an equal opportunity
employer and does not discriminate on the basis of race, color, creed, sex, national origin, sexual orientation, marital
status, religion, political affiliation, veteran status, physical or mental disability or any other legally protected status
unless it is a bona fide occupational requirement reasonably necessary to Agency operations. Certain positions may
require specialized knowledge of the Jewish religion and culture.

REASONABLE ACCOMMODATION: Applicants with disabilities may request reasonable accommodation in the
MJCC’s recruitment and selection process by contacting the Human Resources Manager.

Position Applied For: Date of Application:

Last Name First Name Middle Name

Address City State Zip

Telephone Number(s): Home Cell Email

Have you ever applied for employment with MJCC? Yes No Date & Position:
Have you ever been employed by MJCC? Yes No Dates & Position:
If hired, can you provide proof that you are authorized to work in the United States? Yes No

CRIMINAL RECORD: (Conviction of a crime is not an automatic bar to employment. We consider factors such as the
nature and gravity of the crime, the length of time since the conviction and/or completion of any sentence, and the nature of
the job you have applied for. Do not list any arrest, charge, detention or conviction that has been judicially expunged,
sealed, impounded or eradicated.)
Have you ever been convicted, plead guilty or no contest, or forfeited bond or bail Yes No
for any crime other than traffic violations? (DUII is not considered a traffic violation.)
If yes, please give details:

SKILLS: (Some positions at MJCC require the use of a personal computer. Please indicate your level of skill in the
following areas.)
B = Basic I = Intermediate A = Advanced Blank = No Experience/Skill In This Area
Personal Computer Microsoft Word Microsoft Excel
Calculator/10-Key Microsoft Access Microsoft Power Point

CERTIFICATIONS: (Please check all that apply. Certifications must be Red Cross or equivalent.)
Lifeguard Training CPR (Professional Rescuer) First Aid AED
Water Safety Instructor Personal Trainer Other
 EDUCATION: (Please list your education or training including college and business, technical, trade, correspondence and
military schools, etc.)
Please circle highest year completed: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+

Did you graduate from high school: Yes No GED? Yes No

School Name and Address Course of Study/Major Degree/Certificate

ADDITIONAL INFORMATION: (Use this space to add other job-related information you wish for us to consider.)

WORK EXPERIENCE: Begin with your present position, or, if unemployed, your most recent position. Be
accurate and account for all of your time. Add copies of this page to include additional work experience;
your resume will not substitute for additional pages. Do not write “see resume.” Include all military, non-
paid, or volunteer work related to this position. Use the previous section to account for any gaps in your
employment.

From: To: Employer: May we contact this employer?

Duties: (be specific)

Starting Salary: Supervisor’s Name & Telephone Number: Reason For Leaving:
Ending Salary:
From: To: Employer: May we contact this employer?
Yes No
Position: Address:

Duties: (be specific)

Starting Salary: Supervisor’s Name & Telephone Number: Reason For Leaving:
Ending Salary:
From: To: Employer: May we contact this employer?
Yes No
Position: Address:

Duties: (be specific)

Starting Salary: Supervisor’s Name & Telephone Number: Reason For Leaving:
Ending Salary:
From: To: Employer: May we contact this employer?
Yes No
Position: Address:

Duties: (be specific)

Starting Salary: Supervisor’s Name & Telephone Number: Reason For Leaving:
Ending Salary:
From: To: Employer: May we contact this
employer?
Yes No
Position: Address:

Duties: (be specific)

Starting Salary: Supervisor’s Name & Telephone Number: Reason For Leaving:
Ending Salary:
From: To: Employer: May we contact this employer?
Yes No
Position: Address:

Duties: (be specific)

Starting Salary: Supervisor’s Name & Telephone Number: Reason For Leaving:
Ending Salary:

Signature Page On Reverse

I authorize the investigation of all matters which MJCC deems relevant to my qualification for
employment, including all information given in this application and any attachments, supporting
documents or interviews. I authorize you to request and receive such information and I
release from all liability any persons (e.g. current or former supervisors, coworkers) employers,
or other entities (e.g. schools) supplying it. I also release you and MJCC from all liability that
may result from making the investigation.

I certify that all of the information given in this application and in any attachments, supporting
documents or interviews is (or will be) true and complete to the best of my knowledge. I
understand that any falsification, misrepresentation or omission, as well as any misleading
statements or omissions, generally will result in denial of employment, withdrawal of any offer
of employment, or immediate termination, regardless of when or how discovered.

I understand that I may be required to submit to a criminal background check, pre-or post-
employment physical and other professional examinations, medical inquiries and/or urinalysis
tests for the presence of drugs and/or alcohol. I agree to such examinations, inquiries and/or
testing at MJCC’s expense. I authorize release of the results to MJCC and their use to
evaluate my suitability for employment. I also release MJCC from all liability arising out of or
connected with any examinations, inquiries or testing.

I understand that my employment is “at will,” and I may resign or be terminated, without cause
or notice, at any time. I also understand that the Chief Executive Officer is the only person
who will ever have the authority to agree to any other terms, and that those terms must be in
writing and signed by both parties.

Signature: Date:

Printed Name:

Submit Applications to: MJCC Human Resources Department

Applications returned by e-mail will not be considered. Only signed, complete applications will be
considered. Resumes are optional and do not replace the application form unless noted otherwise in
the job announcement. Applications must be received by 5:00 p.m. on the closing date, unless it is
an open, continuous recruitment.

Unless submitted for an open, continuous recruitment, this application will only be considered active
for the duration of the recruitment and selection period noted on the job announcement. Applications
submitted in open, continuous recruitments will be maintained for four months. You must complete
and submit a new employment application if you wish to be considered for another opening. Further,
due to the volume of applications received, not every candidate who applies for a position will receive
an interview.

MJCC IS AN EQUAL OPPORTUNITY EMPLOYER