Employment Application

Please provide complete and legible information. You may provide a resumé, but you must also complete this form. Please print in ink or type and do not leave any blank spaces.

Oldham County Water District is an Equal Employment Opportunity employer and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin or ancestry, sex, age, physical or mental disability, military or veteran status, genetic information or any other protected basis recognized under federal, state or local laws, regulations or ordinances.

Date*

Date

Position Applied for*

Date you can begin work*

Date

Your Name First, Middle, Last*

Address*

CITY*

STATE*

ZIP CODE*

Contact Number*

555-555-5555

Alternate Contact Number

555-555-5555

E-mail*

example@example.com

Are you legally authorized to work in the United States? If hired, verification will be required consistent with federal law*

Are you under the age of 18?*

Have you ever been convicted of a crime that has not been expunged, sealed, pardoned, annulled, statutorily eradicated or dismissed upon condition of probation? You are not required to disclose sealed or expunged records of conviction or arrest, or expunged juvenile records of conviction or arrest.*

If yes, please explain.

EDUCATION

	School Name and Location	Highest Grade Completed	Course of Study or Major
High School or G.E.D. equivalent
College or University
Vocational or Trade School
Graduate School
Other (including military training if relevant for desired position)

List three professional references (other than those listed as current/former supervisor) that we may contact:

(1) Name Professional Reference*

Telephone No.*

E-mail

example@example.com

Type of Acquaintance*

(2) Name Professional Reference*

Telephone No.*

E-mail

example@example.com

Type of Acquaintance*

(3) Name Professional Reference*

Telephone No.*

E-mail

example@example.com

Type of Acquaintance*

List all employment experiencd, starting with the most recent or present employer. Describe in detail all work experience including periods of unemployment.

Resumés may be attached but not may not be substituted for completing the following employment information.

Current or Most Recent Employer*

Address*

Phone Number*

Job Title

Date Employment Started with Current or Most Recent Employer

(MM-YYYY) Month & Year

Date Employment Ended with Current or Most Recent Employer if you are still employed leave blank

(MM-YYYY) Month & Year

Supervisor's Name/Title

May we contact?

If not, why?

Primary Responsibilities

Reason for Leaving

2nd Most Recent Employer

Address

Phone

Job Title

Supervisor's Name/Title

Date Employment Started with 2nd Most Recent Employer

(MM-YYYY) Month & Year

Date Employment Ended with 2nd Most Recent Employer

(MM-YYYY) Month & Year

Primary Responsibilities

Reason for Leaving

3rd Most Recent Employer

Address

Phone From

Job Title

Supervisor's Name/Title

Date Employment Started with 3rd Most Recent Employer

(MM-YYYY) Month & Year

Date Employment Ended with 3rd Most Recent Employer

(MM-YYYY) Month & Year

Primary Responsibilities

Reason for Leaving

4th Most Recent Employer

Employer Address

Employer Phone Number

Job Title

Supervisor's Name / Title

Primary Responsibilities

Date Employment Started with 4th Most Recent Employer

(MM-YYYY) Month & Year

Date Employment Ended with 4th Most Recent Employer

(MM-YYYY) Month & Year

Reason for Leaving

Please account for any gaps in employment.

I understand that completion of this application does not indicate that there are any open positions and does not in any way obligate Oldham County Water District to hire me or offer me a job.

I understand that Oldham County Water District is an equal opportunity employer and selects individuals based upon job-related qualifications regardless of race, color, religion, creed, national origin or ancestry, sex, age, physical or mental disability, military or veteran status, genetic information or any other protected basis recognized under federal, state or local laws, regulations or ordinances.

I hereby certify that the information I supplied on this employment application is true in all respects. I authorize Oldham County Water District and its representatives to contact my prior employers and all others for the purpose of verification of the information I have supplied, and I release all of them from liability for requesting, providing, or acquiring information about me. I authorize employers, schools and other persons named on this application to provide any information or transcripts requested.

I understand that, if hired, my employment is at will and can be terminated, with or without cause or notice, at any time, by either Oldham County Water District or me. No Oldham County Water District manager or supervisor has the authority to enter into an employment agreement for any specified period of time or to make any agreement contrary to the foregoing “at will” relationship.

I understand that Oldham County Water District reserves the right to use any method of investigation which, at its sole discretion, it deems reasonable and necessary to determine whether any employee has engaged in conduct warranting disciplinary action, including, but not limited to a search of any property of mine on Oldham County Water District premises. As a condition of continued employment, if hired, I agree to cooperate in any such investigation.

I understand that if hired, my continued employment is predicated upon the truthfulness and accuracy of the statements contained herein, and that my employment is subject to termination if any statement in this application is false or misleading. If hired, I agree to conform to the rules and regulations of Oldham County Water District as issued from time to time, and I understand that only current rules and regulations apply to my employment with Oldham County Water District.

I understand, where permissible under applicable state and local law, I may be subject to a pre-employment drug test after receiving a conditional offer of employment.

I understand employment with Oldham County Water District is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.

I understand this application will remain active for six (6) months and if I have not been hired by that date, I must renew my application to be considered for future employment.

BY SIGNING MY NAME IN THE SPACE BELOW, I REPRESENT THAT I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.

Please list any professional memberships, certificates, designations, licenses, honors, awards, fellowships, special qualifications or other data that will assist us in considering your application for employment.

Date*

Date

You May Upload Your Resume Here

Please verify that you are human*

BY SIGNING MY NAME, I REPRESENT THAT I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.*

Oldham County Water District Employment Application

PERSONAL INFORMATION

BACKGROUND INFORMATION

PROFESSIONAL REFERENCES

EMPLOYMENT RECORD

PLEASE READ CAREFULLY BEFORE SIGNING