BestWater of Southwest Kansas Employment Form

Please enter a valid phone number.

Are there any reasons for which you might not be able to perform the job duties (with a reasonable accommodation)?YESNO

NO* (If not, employment is subject to verification of minimum legal age)

ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S?YES

(Give below the names of three persons not related to you, whom you have known at least one year,

Please enter a valid phone number.

Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin or handicap. We are an Equal Opportunity Employer and committed to excellence through diversity. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered.

*Please complete each section EVEN IF you decide to attach a resume. * I certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.

DO NOT WRITE BELOW THIS LINE (EMPLOYER ONLY)

EMPLOYMENT APPLICATION

PERSONAL INFORMATION

FULL NAME:

ADDRESS:

PHONE:

SOCIAL SECURITY NUMBER (SSN):

ANY VIOLATIONS:

LENGTH AT PRESENT ADDRESS:

LENGTH AT PREVIOUS ADDRESS:

EMPLOYMENT ELIGIBILITY

EDUCATION

PREVIOUS EMPLOYMENT

STARTING PAY:

PHONE

PHONE

REFERENCES

MILITARY SERVICE

BACKGROUND CHECK CONSENT

DISCLAIMER

OTHER NOTES:

CONCERNS / QUESTIONS:

MACHINE / EQUIPMENT USE: