State Of Hawaii Department Of Health Hawaii District .

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State of HawaiiDepartment of HealthHawaii District Health OfficeDisease Outbreak Control DivisionHilo, HawaiiEpidemiology and Laboratory Capacity for Infectious Diseases (ELC)Statistics Clerk 2,835 - 3,447 per month, salary commensurate w/ training andexperienceExempt, non-civil service, full-time, temporary appointment. The primary purpose of this position providesindependent generation of standard and routine statistical analyses and reports, using manual and automatedprocedures to process information, the ability to work with other clerical and support staff, and adaptation to thecontinually changing statistical needs of the program.Minimum Qualification(s)EDUCATION:High school diploma or GED is preferred.EXPERIENCE:One (1) year of general clerical experience which demonstrated knowledge of English grammar,spelling, arithmetic, common office appliances and equipment; and the ability to read, understand and follow oraland written instructions, carry out clerical procedures, speak and write simply and directly, observe difference in copyand proofread words and numbers quickly and accurately.One (1) year of specialized experience involving collecting and processing numerical data, demonstrating knowledgeof methods to measure trends and variability, and of graphic and tabular presentation of statistical data.Possession of a bachelor’s degree from an accredited college or university may be substituted for one year of generalclerical experience.Possession of the required number of years of experience will not in itself be accepted as proof of qualification for aposition. The applicant’s overall experience must have been of such scope and level of responsibility as toconclusively demonstrate that they have the ability to perform the duties described.Who May ApplyLEGAL AUTHORIZATION TO WORK REQUIREMENT: The State of Hawaii requires that all persons seekingemployment with the government of the State shall be citizens, nationals, or permanent resident aliens of the UnitedStates, or eligible under federal law for unrestricted employment in the United States.How to ApplyMail cover letter, completed State of Hawaii Application for Non-Civil Service Appointment with original signature,three (3) references, salary requirement and detailed resume to:Department of HealthHawaii District Health OfficeP.O. Box 916Hilo, Hawaii 96721-0916Attn: Kathryn TanakaRecruitment is on continuous until needs are met for position #123446.Other InformationFor additional information, you may contact Kathryn Tanaka at (808) 974-6007 or kathryn.tanaka@doh.hawaii.gov.This position is exempt from civil service. Employment in such positions is considered to be “at will.”Effective immediately, as a condition of employment with the State of Hawai‘i, each qualified candidate who has beengiven a conditional offer of employment must show proof of full COVID-19 vaccination and shall be fully vaccinatedby his/her/their employment start date. A reasonable accommodation will be provided if requested by a candidateand it is determined through an interactive process that pregnancy, a qualifying disability, or a sincerely heldreligious belief prevents the candidate from receiving a COVID-19 vaccination.Please note that the COVID-19 vaccination policy above will apply to both new hires not currently employed by theState of Hawaii Executive branch, as well as current State of Hawaii Executive Branch Employees who are beingconsidered for placement into another State of Hawaii Executive Branch position.An Equal Opportunity Employer09/28/21 Rev. 10/15/21, 11/19/21

S TAT E O F H A W A I ‘ I A P P L I C AT I O NFOR NON-CIVIL SERVICE APPOINTMENTDEPARTMENT OF HEALTHHuman Resources Office – Recruitment & Examination1250 Punchbowl Street, Room 122Honolulu, Hawaii 96813FOR OFFICIAL USE ONLYDEPARTMENTAL PERSONNEL STAFFTO SELECT CATEGORY.Exempt89 DayTAOLRECEIVED DATE/TIME STAMPGENERAL INSTRUCTIONS TO APPLICANT: Please type or print legibly in blue or black ink.The information you provide will be used to determine whether you qualify for the job(s), for which you are applying.Your entire application and attachments (if any) must be received only at the Personnel Office above.This application form is to be used for non-civil service appointments.Before applying, read the position requirements described in the Announcement carefully to determine if you qualify for the position.Any additional required forms described in the Announcement can be obtained from this office.Answer the questions completely and accurately. Your application may be rejected if it is incomplete or you may be disqualified ordismissed from employment if you provide false information.You must notify this office in writing of any changes to your name, addresses, telephone numbers or availability information.We will not be responsible for any mail or correspondence which does not reach you.Your application and supporting documents are confidential and become our property. Please keep copies for your own record.The information you submit on this form may be verified.The information on pages 1 and 2 will not be released to persons involved in the appointment process.The State of Hawai‘i is an equal opportunity employer and complies with applicable state and federal laws relating to employment practices.1.2.3.8. WORK AUTHORIZATIONPlease answer both A and B below:A. Are you legally authorized to work in the UnitedStates? YesNoELC Statistics ClerkPOSITION TITLE APPLYING FOR123446NAME:LastFirstMiddle9. NOTICE OF “AT WILL” EMPLOYMENTOTHER NAMESUSED OR FORMER4.LAST NAME:The job you are applying for is temporary in nature. Therefore,if appointed to the position, your employment will be consideredto be “At Will,” which means that you may be discharged fromyour employment at the prerogative of the department head ordesignee at any time.MAILING5. ADDRESS:P.O. BoxCity6.B. Will you now or in the future require sponsorship bythe State of Hawaii for employment visa statusNo(e.g. H-1B visa status)? YesRECRUITMENT NUMBER or POSITION NUMBERorNumber and StreetStateZip CodeE-MAILADDRESS:CERTIFICATE OF APPLICANTI have been informed and understand that this application is forconsideration of a job that is temporary in duration, has limited orno benefits, and employment, if offered, is only on an “At Will”basis. I hereby certify that all statements in this application aretrue and correct to the best of my knowledge, and I agree andunderstand that any misstatements of material facts herein maycause forfeiture of all rights to any employment in the service ofthe State of Hawai‘i. I have read the terms or conditions stated onthis application and understand that there may be additionalemployment-related tests as required.PHONE7. NUMBER:HomeOtherDateState of Hawai‘i Department of Human Resources DevelopmentPage 1Original Signature of ApplicantForm HRD 278 (Rev. 7/2020)

STATE OF HAWAI‘I APPLICATION FOR NON-CIVIL SERVICE APPOINTMENTThe information on pages 1 and 2 will not be released to persons involved in the appointment process.Information requested in items 10 through 19 is needed to make determinations on your suitability for employment. Dismissalsfrom employment or dishonorable separations from military service do not automatically disqualify you from employment.The circumstances of each individual case will be evaluated against the requirements of the position for which you haveapplied, to determine suitability for employment.10. DISMISSALS FROM EMPLOYMENT AND/OR DISHONORABLE SEPARATIONS FROM MILITARY SERVICEWithin the past five years, were you:A) Fired, terminated for cause, dismissed, discharged or asked to resign from employment?. YES. NOB) Separated from military service under conditions other than honorable? . YES. NO(If you answer “Yes” to question 10A or 10B, please explain in detail in item #11 below, the dates andreasons for your dismissal from employment or separation from military service. For dismissals fromemployment, provide also the name and address of the employer.)11.12. WITHIN THE PAST THREE (3) YEARS, HAVE YOU BEEN CONVICTED OF ANYOFFENSE RELATED TO CONTROLLED SUBSTANCES? . YES.(If you answer “Yes” to the above question, please explain in detail in item #13 below, the dates,nature and circumstances of the conviction; the sentence imposed and its current status; and any otherrelevant information you wish to provide.)13.14. HAVE YOU EVER BEEN CONVICTED OF ANY ACT, ATTEMPT OR CONSPIRACY TOOVERTHROW THE STATE OR FEDERAL GOVERNMENT BY FORCE OR VIOLENCE? . YES .(If you answer “Yes” to the above question, please explain in detail in item #15 below, the dates,nature and circumstances of the conviction; the sentence imposed and its current status; and any otherrelevant information you wish to provide.)15.16. SUSPENSION OR REVOCATION OF LICENSEWas your license or certification to practice in a regulated profession (for example,physician, engineer, nurse, plumber, etc.) ever suspended or revoked? . YES.(If you answer “Yes,” please explain in detail in item #17 below, the type of license; the date; the state; the specificboard or organization that suspended or revoked your license; the circumstances of the suspension or revocation;and any other relevant information you wish to provide.)17.18. SETTLEMENTS OR AGREEMENTSHave you accepted a settlement, a cash buyout such as through the State’s Separation Incentive Programor are you subject to any restriction limiting or precluding you from seeking or securing employmentwith the State of Hawai‘i? . YES.(If you answer “Yes,” to question 18, please explain in detail in item #19 below, the reason and date of your settlementor restriction from applying with the State of Hawai‘i.)19.State of Hawai‘i Department of Human Resources DevelopmentPage 2NONONONOForm HRD 278 (Rev. 7/2020)

STATE OF HAWAI‘I DEPARTMENT OF HEALTHEDUCATION AND EMPLOYMENT HISTORYSTATE OF HAWAI‘I APPLICATION FOR NON-CIVIL SERVICE APPOINTMENTFOR OFFICIAL USE ONLYDEPARTMENTAL PERSONNELSTAFF TO SELECT CATEGORYExempt89 Day1. POSITION TITLE APPLYING FOR: ELC Statistics Clerk2. RECRUITMENT NUMBER or POSITION NUMBER: 123446As required by federal and/or state laws, we do not discriminate3. NAME:on the basis of age, sex (including gender identity or4. OTHER NAMESexpression), religion, race, color, ancestry, national origin,USED OR FORMERLAST NAME:disability, marital status, veteran’s status, sexual t and court record, citizenship, genetic information or anyLastother protected characteristic. The State of Hawai‘i is an equalFirstP.O. BoxorTAOLMiddleNumber and Streetopportunity employer and complies with applicable state andCityfederal laws relating to employment practices.StateZip Code7. PHONE NO.:HomeOther8. EDUCATION HISTORY: When verification is required, the documentation must be submitted at the time of the application. If not, you may not receive creditfor the training and/or your application may be considered incomplete and rejected. The information you provide in this section will be used strictly in the evaluation ofyour qualifications for the position(s) for which you are applying. The information you submit on this form may be verified.DO NOTWRITEIN THISSPACEA. NAME AND LOCATION (city and state) of last grade school attended: (elementary, intermediate or high school)(School name/type)(City/State/Country)Did you graduate?YesNo If no, what grade level did you complete?Did you receive a GED?YesNoB. TRAINING: In-service training, business, trade, armed forces, college or university, graduate of professional schools.Course or MajorField of StudyNAME & ADDRESSNumber of Creditsor Hours CompletedSemesterQuarterKind of Degree,Diploma or CertificateReceived9. LICENSES, CERTIFICATES, OTHER QUALIFICATIONSA. DRIVER’S LICENSE:Yes, I have a valid driver’s license or I am able to obtain a valid driver’s license by the time of appointment.No, I do not have a driver’s license and/or I am not interested in being considered for positions which requirea driver’s license.B. OTHER LICENSES OR CERTIFICATES: Please indicate the kind, registration number, and the State or other licensing authority. If proof ofevidence is required, please submit a photocopy or present for verification.C. KNOWLEDGE OF LANGUAGE OTHER THAN ENGLISH: List thelanguage and check the appropriate block(s). Some positions require the abilityto speak, read, and/or write in a language other than English.LANGUAGESPEAKREADState of Hawai‘i Department of Human Resources DevelopmentD. SPECIAL QUALIFICATIONS: Include membership in professionalor scientific societies, honors, awards, fellowships, publications (list butdo not submit unless requested), etc.WRITEPage 3Form HRD 278 (Rev. 7/2020)

EDUCATION AND EMPLOYMENT HISTORYSTATE OF HAWAI‘I APPLICATION FOR NON-CIVIL SERVICE APPOINTMENTYour Present or Last Position10. EXPERIENCE: Please type or print legibly in ink. Begin with your present or last employment/training and work backwards. Describe allemployment/training, including military service and volunteer work. Use separate blocks if your duties and responsibilities changed while working forthe same employer. To receive full credit for your experience, describe in detail the tasks you were assigned. If you supervised others, explain yourduties as a supervisor and indicate the number and job duties of employees you supervised. If more space is needed provide the information on a blanksheet titled “Experience” and attach it to this form. Information you submit on this form may be verified.Do not submit a resume in place of completing this page.EmployerAddressSupervisor’s Name and TitleCompany Phone NumberCompany URL Internet AddressYour Position Title and DutiesDo you supervise?YesNo If yes, how many employees?From:EmployerAddressSupervisor’s Name and TitleCompany Phone NumberCompany URL Internet AddressYour Position Title and DutiesDid you supervise?YesNo If yes, how many employees?From:EmployerAddressSupervisor’s Name and TitleCompany Phone NumberCompany URL Internet AddressYour Position Title and DutiesDid you supervise?YesNo If yes, how many employees?EmployerAddressSupervisor’s Name and TitleCompany Phone NumberCompany URL Internet AddressYour Position Title and DutiesDid you supervise?YesNo If yes, how many employees?State of Hawai‘i Department of Human Resources DevelopmentPage 4MonthYearTo:MonthFull TimeYearPartTimeVolunteerAverage hours worked per weekReason(s) for leavingMay we contact this employer?MonthYesNoYearTo:MonthFull TimeYearPartTimeVolunteerAverage hours worked per weekReason(s) for leavingMay we contact this employer?YesNoFrom:MonthYearTo:MonthFull TimeYearPartTimeVolunteerAverage hours worked per weekReason(s) for leavingMay we contact this employer?YesNoFrom:MonthYearTo:MonthFull TimeYearPart TimeVolunteerAverage hours worked per weekReason(s) for leavingMay we contact this employer?YesNoForm HRD 278 (Rev. 7/2020)

State of Hawaii Department of Health Hawaii District Health Office Disease Outbreak Control Division Hilo, Hawaii . using manual and automated procedures to process information, the ability to work with other clerical and support . I have a valid driver’s license or I am able to obtain a valid driver’s license by the time of appointment.

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