Rapides Parish Water Works District No. 3

Rapides Parish Water Works District No. 3

EMPLOYMENT APPLICATION
This application will be considered active for only 60 days after its completion. If you wish to be considered for employment after that time, you must submit a new application. You must fill in your own application (please print). Remember, omissions or falsifications will result in ineligibility for employment or immediate dismissal if employed. INCOMPLETE APPLICATION FORMS WILL NOT BE CONSIDERED.
PERSONAL
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Social Security Number
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long at current address?
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long at previous address?
Have you ever been convicted of a crime(s) other than a minor traffic violation?
Explanatory Details
Conviction is not an automatic disqualification. All relevant facts and circumstances will be considered.

General
Position Desired
Wage of Salary Desired
Date Available for Work
Current Position
If you are currently employed, may we contact your employer?
Have you ever worked for our Company?
If yes, when?
Have you previously applied for employment with our Company?
If yes, when?
Why do you desire a change?
List any relatives employed by our Company

Education

Select the highest grade completed
High School
Did you Graduate?
Name of School
Location
College
Did you Graduate?
Name of School
Location
Graduate School
Did you Graduate?
Name of School
Location
Trade School
Did you Graduate?
Name of School
Location
List any academic, professional, trade, civic or social activities, offices held or other related accomplishments. (Exclude those, which may indicate race, color, religion, sex or national origin.)

EMPLOYMENT ELIGIBILITY STATUS:

(Proof of citizenship or immigration status is required upon employment.)
Are you lawfully eligible to be employed in the United States?
EMPLOYMENT HISTORY:

List below all your previous employment. Account for all your timeincluding periods of unemployment. (If you have been self-employed, please give details such as name ofthe firm, location a why business was discontinued.) Begin with your most recent job and work back.
Company
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Type of Business
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Started

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Left

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position
Supervisor's Name
Final Rate of Pay
Description of Duties
Reason for leaving
Company
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Type of Business
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Started

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Left

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position
Supervisor's Name
Final Rate of Pay
Description of Duties
Reason for leaving
Company
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Type of Business
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Started

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Left

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position
Supervisor's Name
Final Rate of Pay
Description of Duties
Reason for leaving
Company
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Type of Business
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Started

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Left

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position
Supervisor's Name
Final Rate of Pay
Description of Duties
Reason for leaving
Please explain any periods during which you were not employed (except for military service)
Have you ever been terminated or asked to resign from a job?
If yes, explain:

Military Service
Branch
Rank at Discharge
Date of Entry

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date of Discharge

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Describe your duties:

Skills
List and describe any special skills, experience, or aptitudes that you feel qualify you for a position with our Company
References

List three business, professional, or other references who can attest to your work capabilities (do not include relatives or former employers).
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Occupation
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Occupation
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Occupation
Notification

In the event of an emergency, notify the following person:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship

Rapides Parish Water Works District No. 3

PERSONAL

General

Education

EMPLOYMENT ELIGIBILITY STATUS:

EMPLOYMENT HISTORY:

Military Service

Skills

References

Notification

IMPORTANT: READ THIS CAREFULLY BEFORE SIGNING & DATING APPLICATION

EQUAL EMPLOYMENT OPPORTUNITY/AFIRMATIVE ACTION DATA