Answer each question fully and accurately. Please print or type. Date ________________
Last Name:First Name:Middle name:
Home Phone:Work Phone:
Social Security #:
Position applied for:
Date available for employment: _____________
Are you seeking: RegularFull-timePart-timeTemporarySummer only
How did you hear about this position? Please specify _____________________________________________________________________
Do you have any relatives currently on staff?YESNO
If yes, give name(s) and relationship(s) _____________________________
Are you 18 years of age or older?YESNO
Have you filed an application here before? YESNO If yes, when? ______________
Are you on a lay-off and subject to recall? YESNO
Have you ever been convicted of anything other than a minor traffic violation?YESNO
If yes, please give the date, place and nature of the charge of which you were convicted. (A conviction will not necessarily disqualify you from employment.) ________________________________________________________________________
If hired, can you furnish proof that you are eligible to work in the United States? (Employment is contingent upon satisfactory proof of eligibility to work in the United States.) YESNO
Have you worked or attended school under any other name?YESNO
If yes, give name(s) ______________________________
May we check with your present employer for a reference?YESNO
Apprentice, business or vocational school:
School and Location
please complete this section even if you plan to attach a resume.List your last three employers, beginning with the most recent. Account for all periods of time including military service and periods of unemployment.
List those familiar with your job performance and personal characteristics who have known you a MINIMUM OF ONE YEAR. DO NOT LIST RELATIVES.
Note: A job offer may be contingent upon acceptable references.
Home & Business Phone Number
PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING
I certify that all information provided in this application and any attachments is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment, or, if I am hired, may result in my dismissal from employment if discovered at a later date.
I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.
I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and that my employment may be terminated at any time, with or without cause and with or without notice. I understand that no employee or representative of Water & Wastewater Services, LLC, other than the Owner, Kelly Wynn, has any authority to enter into any agreement for employment for a specified period of time or to make any agreement contrary to the foregoing.
I have read, understand and consent by my signature to these statements.
PLEASE SUBMIT COMPLETED APPLICATION VIA MAIL, FAX, OR E-MAIL