Employment Application Form

Employment Application

Fill the form below accurately indicating your potentials and suitability to job applying for.
Name

First NameLast Name
Birth Date

MonthDayYear
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How were you referred to us?
Resume and Files

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Please describe any skills or training you currently have
Training and Certifications
Do have one of the following
Training and Certifications
Are you
Do you have a felony conviction
If Yes please explain
References

Please list two (2) references that are familiar with your work life.
Reference
Reference
Can you work? Check all that apply
This job will require employee to be on call nights, weekends, and holidays. Are you willing to adhere to this?
Hired employee will be required to have a CDL or obtain a CDL within 3 months.
If hired employee will be required to complete DEQ certification in 3 months
Please describe any electronic or computer skills
Signature
Please upload a copy of your current driver's license

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Jefferson County Rural Water is an equal opportunity employer
Should be Empty:

Jefferson County Rural Water is an equal opportunity employer