Employment Application - Security Water and Sanitation District

Programs, Services and Employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview.

Date of Interview (Month/Day Year)

How were you referred to us:

Applicant Information

Full Name:

First

Last

M.I.

Date

Address

City

State/Province

Zip/Postal

Country

Phone

Email

Date Available to Start:

Position Applied for:

Are you a citizen of the United States?

YES

NO

If no, are you authorized to work in the U.S.?

YES

NO

Have you ever worked for these Districts?

YES

NO

If yes, when?

Type of employment desired:

Full-Time

Part-Time

Temporary

Seasonal

Salary Desired:

$

Education

High School – Name and Location:

Did you graduate?

YES

NO

Diploma

College - Name and Location

Did you graduate?

YES

NO

Degree

Other – Name and Location:

Did you graduate?

YES

NO

Degree

List your special Skills that would be beneficial to this job:

References

Please list three professional or personal references.

Full Name:

Relationship:

Company:

Phone:

Address:

References Continued

Full Name:

Relationship:

Company:

Phone

Address:

Full Name:

Relationship:

Company:

Phone

Address:

Previous Employment

Please list from most recent to oldest

Company:

Phone

Address:

Supervisor:

Job Title:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Company:

Phone

Address:

Supervisor:

Job Title:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Company:

Phone

Address:

Supervisor:

Job Title:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Military Service

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statement on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the Districts from all liability for any damage that may result from utilization of such information.

Signature

Clear

Date