Job Application Form

*Name

*Phone

*Address

City

State/Zip Code

*Email Address

*Telephone Number

Best Time to Call

*Resume

Position Applied For

Desired Hourly Rate of Pay

Date Available For Work

*Are you authorized to work lawfully in the United States?

Yes

*Will you now or in the future require Widefield Water and Sanitation District to commence an immigration case in order to employ you (for example, H-1B or other employment-based immigration case, sometimes called “sponsorship” for employment-based visa status)?

Yes

*Have you ever been employed by WWSD in the past?

Yes

If yes, what was your position?

Will you work overtime if the position requires it?

Yes

*Drivers License Number

*Drivers License State

Professional Licenses, Skills, and Qualifications

Education

School 1 Name

Number of Years Attended

School 1 Credits Earned

School 1 Degree

School 2 Name

School 2 Number of Years Attended

School 2 Credits Earned

School 2 Degree

School 3 Name

School 3 Number of Years Attended

School 3 Credits Earned

School 3 Degree

Employment History

Employer #1

Employer Address

City

State

Title

Dates of Employment

Reason for Leaving

Immediate Supervisor's Name

Summarize your Job Responsibilities

Employer #2

Employer Address

City

State

Title

Dates of Employment

Reason for Leaving

Immediate Supervisor's Name

Summarize your Job Responsibilities

Employer #3

Employer Address

City

State

Title

Dates of Employment

Reason for Leaving

Immediate Supervisor's Name

Summarize your Job Responsibilities

Professional Organizations and/or Affiliations

Name of Organization

Officer or Position

Name of Organization

Officer or Position

Name of Organization

Officer or Position

Name of Organization

Officer or Position

Is there any other work-related infomation that you would like us to know about you?

Professional References (please try to not list personal references)

Name

Realtionship

Years Known

Phone Number

Name

Relationship

Years Known

Phone Number

Name

Realtionship

Years Known

Phone Number

Application Statement – Important, Do Not Sign Until You Have Read. I certify that all of the information I have provided in order to apply for and secure work with this employer is true, complete, and accurate. I understand that falsifying information on this application may prevent me from obtaining employment with this employer. I also understand that providing false information if discovered after you have obtained employment with this employer may result in immediate termination of employment. I expressly authorize, without reservation, the employer or its representatives to contact and obtain information from all references provided, past employers, licensing authorities, and educational institutions. I realize and authorize Widefield Water and Sanitation District to conduct a complete background check on me, including a criminal background check, prior to offering me employment. All positions at Widefield Water and Sanitation District are “At Will” positions. If hired, you are free to resign at any time without cause or notice. The employer reserves the right to terminate my employment at any time with or without cause and without notice, except as may be required by law. I certify that I have read, fully understand, and accept all terms of the foregoing Application Statement.

*Signature Of Applicant

Date

Supplemental Questions

Why do you want to work at Widefield Water and Sanitation District?

Why is this a good time in your career to make a change?

What are you seeking in your career that you feel Widefield Water and Sanitation District can offer you?

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