• Employment Application

  • Applicant Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Eligibility and Application History

  • Are you legally eligible to work in the United States?*
  • Are at least 18 years of age?*
  • Have you previously applied for employment with the Helendale Community Services District?*
  • Have you ever been employed by the Helendale Community Services District?*
  • Are you a current or former CalPERS member?*

  • Education and Qualifications

    Beginning with your most recent employment first, list ten years of experience in job order. Please explain any gaps in employment. Use a separate block for each job title even if employment was with the same organization. Use additional sheets if necessary. If hours varied, give average. Include all information requested. You may include information pertaining to unpaid or volunteer experience on a separate sheet of paper.Resumes may be attached for additional information but will not be accepted in lieu of a completed District Application.
  • From Date (Employment 1)
     - -
  • To Date (Employment 1)
     - -
  • Format: (000) 000-0000.
  • May we contact this employer? (Employment 1)
  • From Date (Employment 2)
     - -
  • To Date (Employment 2)
     - -
  • Format: (000) 000-0000.
  • May we contact this employer? (Employment 2)

  • Licenses, Certificates, and Memberships

  • Expiration Date
     - -
  • Professional/Civic Memberships

  • Skills and Additional Information

  • Applicant Statement

    I certify that the statements given by me in this application are true, complete, and correct to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that if offered employment, the offer may be contingent on passing a pre-employment drug screen and a pre-employment physical and a criminal background check and any positive results may disqualify me. I voluntarily agree to submit to these procedures. I also acknowledge that, if hired, I may be randomly called for required drug and alcohol screens and I voluntarily agree to submit to such screens. I also understand that I will be required to submit proof of my identity and legal right to work in the United States on my first day of employment If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid California driver’s license. I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or false or misleading information on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I understand that I am required to abide by all Personnel Policies and Procedures of the Helendale Community Services District. I hereby authorize Helendale Community Services District to thoroughly investigate my employment history, education, and other matters related to my suitability for employment, without giving me prior notice of such disclosure. In addition, I hereby release Helendale Community Services District from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. I understand that nothing contained in the application, or conveyed during any interview that may be granted, is intended to create an employment contract between Helendale Community Services District and me. I also understand and agree that no representative of the Helendale Community Services District has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.
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  • Optional

  • The Equal Employment Opportunity Commission and California Fair Employment and Housing Council require employers to obtain certain information from each job applicant in order to comply with equal employment opportunity recordkeeping and reporting requirements. This form is used to invite applicants to self-identify gender and race for those purposes. This form will be detached and kept separate from your application.
    Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. Responses will remain confidential and will be used only for the necessary information to include in our reporting requirements to the government. When reported, data will not identify any specific individuals.

  • Race
  • Gender
  • Should be Empty: