Form F 82006 PDF Details

At the heart of ensuring a diverse and inclusive workforce within the state of Wisconsin's Department of Health Services lies the F 82006 form, a critical tool in the employment application process. This document serves as an Employment Application Supplement, specifically designed to facilitate the hiring of limited-term employees or those engaged in project-based work, underlining the state's commitment to equal opportunity employment and affirmative action. The form gathers comprehensive information from applicants, ranging from basic personal details to more specific employment preferences, legal work status in the United States, and the capacity for mobility necessary for the job. Additionally, it explores the educational background of the applicant, alongside any special qualifications, languages spoken, licenses, memberships, and other skills, offering a multifaceted view of the candidate’s capabilities and fit for potential roles. Emphasizing thoroughness, it requires applicants to disclose their employment history in detail, encouraging transparency regarding any periods of unemployment. By doing so, the F 82006 form not only aligns with federal law requirements, such as the need to complete the Employment Eligibility Verification form (Form I-9) but also supports the state’s affirmative action plan, ensuring all candidates are considered fairly for opportunities across Wisconsin's diverse counties.

QuestionAnswer
Form NameForm F 82006
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other nameswi employment form get, employment application wisconsin get, wisconsin unemployment application, how to wisconsin employment application

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DEPARTMENT OF HEALTH SERVICES

STATE OF WISCONSIN

F-82006 (05/2015)

EMPLOYMENT APPLICATION SUPPLEMENT

AN EQUAL OPPORTUNITY EMPLOYER FUNCTIONING UNDER AN AFFIRMATIVE ACTION PLAN

Instructions: A copy of all Employment Application Supplement forms marked LTE (limited-term employee) or Project should be sent to the Department of Health Services, Affirmative Action/Civil Rights Office, 1 West Wilson Street, P O Box 7850, Madison WI 53707-7850.

Application Date

Position Title

Name – Applicant (print clearly)

Daytime Telephone Number

Nighttime Telephone Number

Other Telephone Number

Mailing Address – Street / PO Box / Rural Route

City

State

Zip Code +4

Are you a Wisconsin resident?

Yes

No (Wisconsin residency is required for LTE and project employment.)

 

 

 

 

 

 

 

Date Available for Employment

 

Employment Preference

Shift Preference

 

 

 

 

Full Time

Part Time

First

Second

Third

 

 

 

 

 

 

Are you currently legally authorized to work in the United States?

 

 

Yes

No

Will you now, or in the future, require sponsorship for employment visa status (e.g., H-1B visa status)?

Yes

No

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 form (Form I-9) upon hire.

Do you have a valid Wisconsin driver’s license or eligibility to obtain one?

Yes

No

 

 

 

If a job requires, would you be able to travel?

Yes

No

 

 

 

Have you ever been employed with the state of Wisconsin?

If yes, please provide the dates and where you were employed:

Yes

No

EDUCATION / TRAINING

Formal Education / Training Beyond High School Organization – Name and Location

Dates Attended

From

To

 

 

Major / Minor Field(s)

Degree

Year

SPECIAL QUALIFICATIONS

Foreign Language(s) – List Language Skills(s)

Verbal

Written

Current License / Registration Memberships – List Name(s) of Professional / Technical Association(s)

Other Skills / Qualifications (Include typing, office skills, technical vocabulary, etc.)

Geographic Location(s) You Will Consider for Employment

County Code(s)

/

/

/

/

/

/

/

/

/

F-82006

Page 2 of 3

EMPLOYMENT HISTORY

This section must be completed even if you supply a resume. List all employment chronologically beginning with present or most recent employment first. List all employment for the last 10 years. Include any part-time, internship, or volunteer work experience. Please provide an explanation for any gaps in your employment history. If necessary, attach additional sheets using the format below to provide additional employment data or references. References listed below, may be contacted in addition to any others the employer deems necessary. Please verify that daytime number listed is accurate.

Name – Employer

 

 

 

Duties / Responsibilities

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

 

 

 

City

 

State

 

Zip Code

 

 

 

 

 

 

 

Position held

 

 

 

 

 

 

 

 

 

Supervisor (Reference)

Telephone Number

 

 

 

 

 

 

Dates of Employment

 

 

 

 

 

 

 

 

 

 

Hours Per Week

 

 

 

 

 

Full Time

Part Time

Volunteer

 

 

 

 

 

 

 

Name – Employer

 

 

 

Duties / Responsibilities

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

 

 

 

City

 

State

 

Zip Code

 

 

 

 

 

 

 

Position held

 

 

 

 

 

 

 

 

Supervisor (Reference)

Telephone Number

 

 

 

 

 

 

Dates of Employment

 

 

 

 

 

 

 

 

 

 

Hours Per Week

 

 

 

 

 

Full Time

Part Time

Volunteer

 

 

 

 

 

 

 

Name – Employer

 

 

 

Duties / Responsibilities

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

 

 

City

 

State

 

Zip Code

 

 

 

 

 

 

 

Position held

 

 

 

 

 

 

 

 

Supervisor (Reference)

Telephone Number

 

 

 

 

 

 

Dates of Employment

 

 

 

 

 

 

 

 

 

 

Hours Per Week

 

 

 

 

 

Full Time

Part Time

Volunteer

 

 

 

 

 

 

 

 

If one of the references you’ve provided would know you by a different name, please indicate that name:

I understand that all the information on this application is true and complete to the best of my knowledge and that any false or missing job related information may disqualify me for this position.

SIGNATURE – Applicant

Date Signed

F-82006

Page 3 of 3

COUNTIES WHERE YOU WILL ACCEPT EMPLOYMENT (PLEASE NOTE THAT COUNTY CODES HAVE CHANGED.)

At least one code is required to process your application. Select the desired code(s) below for the county(ies) where you will accept work and transfer that 2-digit number to the County Code section at the bottom of page 1 of this application. We will only consider you for jobs in the

locations you indicate on your application.

Code

County

Code

County

Code

County

Code

County

Code

County

00 –

All Counties

15 –

Door

30 –

Kenosha

44 –

Outagamie

59 –

Sheboygan

01 –

Adams

16 –

Douglas

31 –

Kewaunee

45 –

Ozaukee

60 –

Taylor

02 –

Ashland

17 –

Dunn

32 –

La Crosse

46 –

Pepin

61 –

Trempealeau

03 –

Barron

18 –

Eau Claire

33 –

Lafayette

47 –

Pierce

62 –

Vernon

04 –

Bayfield

19 –

Florence

34 –

Langlade

48 –

Polk

63 –

Vilas

05 –

Brown

20 –

Fond du Lac

35 –

Lincoln

49 –

Portage

64 –

Walworth

06 –

Buffalo

21 –

Forest

36 –

Manitowoc

50 –

Price

65 –

Washburn

07 –

Burnett

22 –

Grant

37 –

Marathon

51 –

Racine

66 –

Washington

08 –

Calumet

23 –

Green

38 –

Marinette

52 –

Richland

67 –

Waukesha

09 –

Chippewa

24 –

Green Lake

39 –

Marquette

53 –

Rock

68 –

Waupaca

10 –

Clark

25 –

Iowa

72 –

Menominee

54 –

Rusk

69 –

Waushara

11 –

Columbia

26 –

Iron

40 –

Milwaukee

55 –

St. Croix

70 –

Winnebago

12 –

Crawford

27 –

Jackson

41 –

Monroe

56 –

Sauk

71 –

Wood

13 –

Dane

28 –

Jefferson

42 –

Oconto

57 –

Sawyer

99 –

Outside Wisconsin

14 –

Dodge

29 –

Juneau

43 –

Oneida

58 –

Shawano

 

 

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