BIG BEND WATER AUTHORITY Employment Application Form

 

PLEASE COMPLETE PAGES 1-4.

DATE ________________________________

Name __________________________________________________________________________________________

                        Last                                                                 First                                                                Middle                                                            

Present address __________________________________________________________________________________

                                                                        Number                                                          Street                                      City                 State                Zip

How long  at current address _________________________

Social Security No. _______ –  _____    _________

Telephone (      )                                

Are you under age 18 ____YES ____NO, if “YES”, can you provide proof of your eligibility to work? ____YES ____N0

Are you currently authorized to work in the United States? ____YES _____NO.  Proof of eligibility will be required if hired.


Position applied for  (1)_______________________

and wage desired   (2) _______________________

(Be specific)

Days/hours available to work

No Pref _______ Thur _________

Mon _________   Fri __________

Tue __________   Sat _________

Wed _________   Sun _________

How many hours can you work weekly? _______________________   

Employment desired          qFULL-TIME ONLY              qPART-TIME ONLY              qTEMPORARY/CONTRACT

When are you available to start work? ____________________________

________________________________________________________________________________________________

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION

NUMBER OF YEARS COMPLETED

MAJOR & DEGREE

High School

College

Bus. or Trade School

Professional School

Have you ever been convicted of a crime?   q No     q Yes     (A Conviction record will not necessarily disqualify you from employment.)

BBWA is an EOE/DFWP.

Employee Referral?  Name____________________________________________  Years acquainted___________________

Business________________________________    Address____________________________________

City______________________State_____________________Zip_______________Phone___________________________

Employee Referral?  Name____________________________________________  Years acquainted___________________

Business________________________________    Address____________________________________

City______________________State_____________________Zip_______________Phone___________________________

Employee Referral?  Name____________________________________________  Years acquainted___________________

Business________________________________    Address____________________________________

City______________________State_____________________Zip_______________Phone___________________________

Employee Referral?  Name____________________________________________  Years acquainted___________________

Business________________________________    Address____________________________________

City______________________State_____________________Zip_______________Phone___________________________

May we contact your present employer?        q Yes     q No

Did you complete this application yourself    q Yes     q No   If not, who did? _______________________________             

After reviewing the attached job description, please indicate if you are able to perform the essential functions of the job for which you have applied, with or without a reasonable accommodation _____ Yes _____ No. 

 

APPLICATION FOR EMPLOYMENT

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES?                   q Yes     q No

ARE YOU NOW A MEMBER in the ARMED FORCES?                q Yes     q No

Specialty _________________________________ Date Entered ________________ Discharge Date ______________

Work Experience

Please list your work experience for the beginning with your most recent job held.
If you were self-employed, give firm name. 
Attach additional sheets if necessary.

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number

From

To

Start

Final

Your last job title

Reason for leaving (be specific)

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number

From

To

Start

Final

Your Last Job Title

Reason for leaving (be specific)

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number

From

To

Start

Final

Your last job title

Reason for leaving (be specific)

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number

From

To

Start

Final

Your last job title

Reason for leaving (be specific)

                             

 

 

 

PLEASE READ CAREFULLY

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

This employment application form was designed to comply with Federal and State employment laws governing discrimination in employment.  This application form is made for general use and distribution in the United States, and the manufacturer cannot assume responsibility for the inclusion in this form of any questions by the employer which may be at variance with applicable Local, State, or Federal Laws.

                Thank you for completing this application form and for your interest in our business.

___________________________________     _________________________________            ________________

Applicant Signature                                                    Print                                                                Date

Big Bend Water Authority is an EOE/DFWP.

DO NOT WRITE IN THE SPACE BELOW

Interview by: __________________________________    Date: ______________________________

Hired:   Yes_______ No ______ Position______________________ Salary/Wage: ______________

Dept. _____________________________ Date Reporting to Work ___________________________