We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related mental or physical disability, or any other legally protected status.


    Position(s) Applied For:


    Date of Application:

    How did you learn about us?
    AdvertisementFriendWalk-InEmployment AgencyRelativeOther


    Last Name:


    First Name:


    Middle Name:


    Address (Street):


    City:


    State:


    Zip:

    Contact Numbers


    Daytime:


    Evening:


    E-Mail:

    Mark one
    If you are under 18 years of age, can you provide required proof of your eligibility to work?
    YesNo
    Have you ever filed an application with us before?
    YesNo
    If yes, give date:

    Have you ever been employed with us before?
    YesNo
    If yes, give date

    From:
    To:

    Are you currently employed?
    YesNo

    May we contact your present employer?
    YesNo

    Salary desired:

    Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment.)
    YesNo

    On what date would you be available for work?

    Are you currently available to work:
    Full TimePart TimeTemporary

    Are you currently on "lay off" status and subject to recall?
    YesNo

    Can you travel if a job requires it?
    YesNo

    EDUCATION


    High School:


    Graduated?


    Year Completed:


    City, State:


    Course of Study:


    Undergraduate College/ University:


    Graduated?


    Year Completed:


    City, State:


    Course of Study:


    Graduate/ Professional:


    Graduated?


    Year Completed:


    City, State:


    Course of Study:

    Describe any specialized training, apprenticeship, skills and extra curricular activities:

    Describe any honors you have received:

    State any additional information you feel may be helpful to us in considering your application:

    Please Note: Education beyond the requirements on the job description or not related to the job for which you are Applying need not be listed.

    Indicate any languages, other than English, that you can speak, read and/or write.


    Speak:


    Skill Level:
    FluentGoodFair


    Read:


    Skill Level:
    FluentGoodFair


    Write:


    Skill Level:
    FluentGoodFair

    List professional, trade, business or civic activities and offices held. You may exclude memberships which would reveal sex, race, religion, national origin, age ancestry or other protected status.

    EMPLOYMENT EXPERIENCE

    Start with your present or last job. Include military service assignments and volunteer activities which relate to the job for which you are applying. You may exclude organizations which indicate race color, religion, gender, national origin, mental or physical disability or other protected status.


    Current/Previous Employer:


    Start Date:


    End Date:


    Address (city, state, zip):


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    Reason for Leaving:

    #2 Employer


    #2 Employer:


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    #3 Employer


    #3 Employer:


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    #4 Employer


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    #5 Employer


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    #6 Employer


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    Reason for Leaving:


    Special Skills and Qualifications
    Summarize special job-related skills and qualifications acquired from employment or other experience.

    REFERENCES
    Give name, address and telephone number of three business references who are not related to you:


    Ref #1 Name:


    Address:


    Years Known:


    Telephone:


    Ref #2 Name:


    Address:


    Years Known:


    Telephone:


    Ref #3 Name:


    Address:


    Years Known:


    Telephone:


    Ref #4 Name:


    Address:


    Years Known:


    Telephone:


    Ref #5 Name:


    Address:


    Years Known:


    Telephone:

    Have you every had any training in the United States Military which is related to the job for which you are applying?
    YesNo
    If yes, please describe:

    Do you have the physical and mental ability to perform the tasks on the attached job description, with or without accommodation?
    YesNo
    If accommodation is necessary, please describe below:

    Applicant's Statement

    ==>> I certify the answers given herein are true and complete to the best of any knowledge.

    ==>> I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand and acknowledge that the policy of the Bard Water District is such that the existence of a criminal conviction will not necessarily disqualify my application for employment.

    ==>> I understand that if offered employment, the offer may be contingent on passing a pre-employment alcohol and drug screen and a pre-employment physical and voluntarily agree to submit to these procedures. I also understand that I will be required to submit proof of my identity and legal right to work in the United States on my first day of employment.

    ==>> If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid driver's license and understand that I will be required to provide a copy of my official driving record and proof of insurance.

    ==>> This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

    ==>> I understand and hereby acknowledge that any employment relationship with Bard Water District is of an "at will" nature, which means that the employee may resign at any time and the Bard Water District may discharge the employee at any time with or without cause. I also understand that this "at will" employment relationship may not be changed by any written document or by conduct, unless such change is specifically acknowledged in writing by an authorized executive of the Bard Water District.

    ==>> In the event of employment, I understand that false or misleading information given in any application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Bard Water District.

    ==>> Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Bard Water District, I am entitled to copies of any such records obtained, unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.

    I waive receipt of a copy of any public record described in the paragraph above


    Signature of Applicant:


    Date:



    PRE-EMPLOYMENT DRUG SCREEN REQUIRED

    Notes:

    Attach File: