Test-Forms Employment Application-TestThis application must be completed in full and signed. Incomplete or unsigned applications will not be considered. By filling out this application, you are neither guaranteed an interview or a job. A resume may be attached, but does not take the place of the application.Please enable JavaScript in your browser to complete this form. - Step 1 of 4Date:Position Applied For:Name: *FirstMiddleLastAddress: *Address Line 1CityState / Province / RegionPostal CodeWebsite / URL:Phone:Email:Drivers License #: *DL State: *License Expiration Date: *CDL? *YesNoIf employed and you are under the age of 18, can you furnish a work permit?YesNoHave you filed an application here before?YesNoIf yes, Date:Have you ever been employed here before?YesNoIf Yes, Date:Are you employed now?YesNoAre you legally eligible for employment in this country?YesNo(Proof of U.S. Citizenship or immigration status will be required if employed.)Are you available to work:Full-TimePart-TimeTemporaryDate available for work:Are you on a lay-off and subject to recall?YesNoCan you travel if a job requires it?YesNoIf employed, can you comply with the Springdale Water Utilities residency requirement? (Please inquire if clarification needed)YesNoHave you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment to a felony within the last 7 years?YesNoIf Yes, please explain:NextREFERENCES: List three (3) references. Do not include current or past employers, relatives, or past/present employees of the Springdale Water Utilities. Provide full name, address (city and state), and phone number.NAME:ADDRESS:PHONE NUMBER:NAME (2)ADDRESS (2)PHONE NUMBER (2)NAME (3)ADDRESS (3)PHONE NUMBER (3)High SchoolHS Name & State:Highest Level Completed:Degree:Major:Trade/TechnicalName and State of School:Highest Level Completed:Degree:Major:UndergraduateName and State of School:Highest Level Completed:Degree:Major:Graduate/Post GraduateName and State of School:Highest Level Completed:Degree:Major:List any Professional Certifications that you have:Do you currently have a Water Operator’s License? *YesNoState: *Classification: *License Number: *Do you currently have a Waste Water Operator’s License? *YesNoST: *Classification: *License Number: *NOTICE TO INDIVIDUALS WITH DISABILITIES, DISABLED VETERANS AND VIETNAM ERA VETERANSGovernment contractors are subject to 38 USC 2012 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action of employ and advance in the employment of qualified disabled veterans and veterans of the Vietnam Era, Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment of qualified handicapped individuals. If you are a disabled veteran or have a physical or mental disability, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job to the best of your ability in a proper and safe manner. This information will not jeopardize or adversely affect your consideration for employment.If you wish to be identified, please sign below:HandicappedDisabled VeteranVietnam VeteranSignature:NextEmployment HistoryEmployer (1):Job Title (1):Address (1):Supervisor (1):Phone (1):From-To Dates (1):Hrs./Week (1):May we contact this employer (1)?YesNoWork Performed (1):Reason for leaving (1)?Employer (2):Job Title (2):Address (2):Supervisor (2):Phone (2):From-To Dates (2):Hrs./Week (2):May we contact this employer (2):YesNoWork Performed (2):Reason for leaving (2)?Employer (3):Job Title (3):Address (3):Supervisor (3):Phone (3):From-To Dates (3):Hrs./Week (3):May we contact this employer (3):YesNoWork Performed (3):Reason for leaving (3)?Employer (4):Job Title (4):Address (4):Supervisor (4):Phone (4):From-To Dates (4):Hrs./Week (4):May we contact this employer (4):YesNoWork Performed (4):Reason for leaving (4)?NextWho referred you to our company?EmployeeEmployeeNewspaper AdRelativeFriendEmployment AgencyOtherPlease List Referral:Veteran of the U.S. Military Service?YesNoIf Yes, Branch:Upload Resume: Click or drag files to this area to upload. You can upload up to 6 files. Accepted file types: .jpg, .jpeg, .png, .gif, .bmp, .tif, .tiff, .pdf, .doc, .docx, .ppt, .pptx,Employment Application Agreement *I agree *I certify that the information contained in this application is correct and I have not omitted any information. I understand that falsification or omission of information shall result in immediate dismissal. I understand that in processing my Employment Application, Springdale Water Utilities may request that an investigative consumer report may be prepared which may include information as to my character, general reputation, police record, personal characteristics and mode of living. I may request that Springdale Water Utilities disclose to me the nature and scope of the investigation requested by a written request to the Human Resource Director within ten days after I complete this application. I understand that in processing my Employment Application, Springdale Water Utilities may request that I undergo certain medical examinations, drug screening tests, polygraph examinations, voice stress analyzers, attitude tests, breath analysis test and other tests and examinations. I agree and acknowledge that my employment with Springdale Water Utilities is conditional upon my submitting to such tests and examinations which may be requested of me and provided at the expense of Springdale Water Utilities. I authorize the schools, references, and my prior employers listed above to provide my records, reason for leaving, and all other information they may have concerning me and I release all parties from any and all liability or claims for damages whatsoever that my result. I agree and acknowledge that none of Springdale Water Utilities representatives other than the Executive Director has the authority to make any oral or written agreements for employment for a specified time or for specified condition of my employment. I further agree and acknowledge that any agreement for employment for a specified period of time or specific conditions of my employment must be reduced to writing and signed by me and the Executive Director. I agree and acknowledge that my employment can be terminated, with or without cause or notice, at any time by myself or Springdale Water Utilities. I agree to abide by and conform to the rules and regulations of Springdale Water Utilities. I certify and declare under the penalty of perjury that the foregoing is true and correct.APPLICATION WILL BE KEPT ON FILE FOR 90 DAYS AND THEN DESTROYED UNLESS RENEWED BY APPLICANT.Submit Return Home
