Step 1 of 6 0% Personal InformationName(Required) First Last Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Other Contact NumberEmail(Required) Social Security Number(Required) Do You Have the Legal Right to Live and Work in the U.S.?(Required)Proof of citizenship or immigration status will be required upon employment. Yes No Emergency Contact Name(Required) Emergency Contact Phone(Required)Are You 18 Years or Older?(Required) Yes No How Did You Find Out About This Position?(Required) District Website Newspaper Relative Friend Other Employment DesiredPosition(s) Applying For(Required) Part Time or Full Time(Required) Part Time Full Time Shift Preference(Required) 1st 2nd 3rd Date You Can Start (mm/dd/yyyy)(Required) Month Day Year Salary Desired(Required)Have You Ever Applied to the District Before?(Required) Yes No When? Have You Previously Worked for the District?(Required) Yes No When? List and Relatives Employed by the DistrictClick the + button to add another entryNameDepartmentRelationship Add RemoveCan You Travel if the Job Requires It?(Required) Yes No EducationUpon employment, the successful applicant may be required to provide proof of graduation or G.E.D.EducationClick the + button to add another entryName and Location of SchoolHighest Level CompletedDid You Graduate?Field of Study Add RemoveList any special equipment or machines you can operateList any computer software in which you have skills, including word processing, spreadsheets, and database programsPlease indicate the name of the specific softwareList any special clerical skills, including keyboardingAre you a veteran?(Required) Yes No What branch of service? Rank Length of Service Licenses, Registrations, and CertificationsUpon employment, the successful applicant must provide copies of all licenses/certifications required for the position.Driver's License Number State License Number Expiration Date Commercial Drivers License?(Required) Yes No Other License/CertificationLicense/CertificationLicense/Certification NumberExpiration Date Add RemovePersonal ReferencePersons you have known for at least 1 year(Required)Do not include former employers or relatives. Click the + to add another entryName and OccupationAddressTelephoneYears Known Add Remove Employment HistoryAre you currently employed?(Required) Yes - full time Yes - part time No Do you have prior public service experience working for the State of Ohio or a political subdivision of the State?(Required) Yes No Beginning with your most recent, list present and past employment. All sections must be completed for each employer. Include additional Employment History sheets to reference your complete work history. Do not omit employers in history.Employer(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Type of Business(Required) Position(s) Held(Required) Supervisor's Name(Required) Was this a supervisory position? Yes No Number of employees supervisedPosition Type(Required) Full-Time Part-Time Temporary Hire Date (mm/dd/yyyy)(Required) Month Day Year Ending Date (mm/dd/yyyy)(Required) Month Day Year Reason for Leaving(Required) Describe job duties(Required)Additional Employment?(Required) Yes No Employer(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Type of Business(Required) Position(s) Held(Required) Supervisor's Name(Required) Was this a supervisory position? Yes No Number of employees supervisedPosition Type(Required) Full-Time Part-Time Temporary Hire Date (mm/dd/yyyy)(Required) Month Day Year Ending Date (mm/dd/yyyy)(Required) Month Day Year Reason for Leaving(Required) Describe job duties(Required)Additional Employment?(Required) Yes No Employer(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Type of Business(Required) Position(s) Held(Required) Supervisor's Name(Required) Was this a supervisory position? Yes No Number of employees supervisedPosition Type(Required) Full-Time Part-Time Temporary Hire Date (mm/dd/yyyy)(Required) Month Day Year Ending Date (mm/dd/yyyy)(Required) Month Day Year Reason for Leaving(Required) Describe job duties(Required) Summary of QualificationsDescribe briefly the experience, education, training, and other factors that qualify you for the position for which you are applying. Refer to the Minimum Qualifications and any position-specific qualifications posted for the position(Required) Cover Letter & ResumeCover LetterResume UploadMax. file size: 256 MB.Release & AuthorizationRelease and Authorization(Required) I certify that the facts contained in this application are true and complete to the best of my knowledge and belief. I understand that this application must be completed in full or it may not be considered.I certify that I can perform the essential function of the job for which I have applied, with or without reasonable accommodation.I understand that falsified statements or misleading information given in my application or interview(s) may result in discharge from employment regardless of when such information is discovered.I authorize Northwestern Water and Sewer District to obtain copies of my work record and educational history from my former employers and/or educational institutions.I authorize The District to obtain an abstract ofmy driver's license or commercial driver's license record, as well as any prior criminal convictions as it relates to the position for which I am applying.I release all parties from all liability for any damage that may result from the release and use of medical, educational, and employment-related information to Northwestern Water and Sewer District.I understand that any offer of employment is conditioned upon proof of legal authorization to work in the United States as required by the Immigration Reform and Control Act and other applicable laws. I further understand that my social security number must be provided upon employment.I understand that a post-employment physical examination or drug screening may be required for certain positions.In the event that I am hired, I authorize Northwestern Water and Sewer District to update and supplement this information during my employment with the DistrictIn consideration of Tne District's review of my application, I agree that any claim or lawsuit arising out of my empioyment with, or my application for employment with Northwestern Water and Sewer District, its officials, boards, and agencies must be filed no more than six months after the date of the employment action that is the subject of the claim or lawsuit. While I understand that the statute of limitations for claims arising out of an employment action may be longer than six months, I agree to be bound by the six month period of limitation set forth herein, and I waive any statue of limitation to the contrary.Should a court determine in some future lawsuit that this provision allows an unreasonably short period of time to commence a lawsuit, the court shall enforce this provision as far as possible and shall declare the lawsuit barred unless it was brought within the minimum reasonable time within which the suit should have been commenced.Applicant's Electronic Signature (Full Name)(Required)
