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*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How were you referred to us?*

Walk-InReferralNewspaper AdFacebookTwitterLinkedInOther (please specify)
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*

High School DiplomaGED
Training and Certifications
Are you*

A U.S. CitizenAuthorized to work in the United States
Do you have a felony conviction*

YesNo
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*

DaysNightsWeekends
This job will require employee to be on call nights, weekends, and holidays. Are you willing to adhere to this?*

YesNo
Hired employee will be required to have a CDL or obtain a CDL within 3 months.*

I have a CDL currentlyI will obtain a CDL in 3 months if hiredI cannot obtain a CDL
If hired employee will be required to complete DEQ certification in 3 months*

I currently have a CDL certificationI will complete the required certification if hired within 3 monthsI cannot obtain DEQ certificationType option 4
Please describe any electronic or computer skills*
Signature*

Clear
Please upload a copy of your current driver's license*

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Jefferson County Rural Water is an equal opportunity employer
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Employment Application

Jefferson County Rural Water is an equal opportunity employer