REFERENCES: 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.
NOTICE TO INDIVIDUALS WITH DISABILITIES, DISABLED VETERANS AND VIETNAM ERA VETERANS
Government 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.
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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.