WELCOME
TO THE KITTERY WATER DISTRICT
Over A Century Of Delivering Safe, Clean Drinking Water
" From Pristine Reservoirs To Your Tap"
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Over A Century Of Delivering Safe, Clean Drinking Water " From Pristine Reservoirs To Your Tap"
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( to print this application, print in landscape orientation)
KITTERY WATER DISTRICT Application for Employment PERSONAL INFORMATION Name ____________________________________Home Phone ___________________ Address ______________________ City _________________ State ______ Zip ______ Date of Birth * _________ Social Security # _____________ Cell Phone ____________ * The Age Discrimination
in Employment Act of 1967 prohibits discrimination on the basis of age **Married: ( ) YES ( ) NO Children:
( ) YES ( ) NO Sex: ( ) Male ( ) Female Citizen of the United States: ( ) YES ( ) NO If no, are you lawfully authorized to work in the United States? __________ If you have a temporary work authorization give date of expiration ______________ Do you have a valid Commercial Driver's License (CDL): ______ If yes what class: ____ Do you have a valid driver's license: ______ State: ________ License #: ____________ Do you have any backhoe experience: _______________________________________ Do you have any experience installing water pipe: ______________________________ Do you have
any other construction experience, knowledge or operation of machinery ______________________________________________________________________ Have you ever been convicted of a motor vehicle moving violation: ( ) YES ( ) NO If yes when: _______________________ Explain violation: ____________________ _____________________________________________________________________ Have you ever been involved in a motor vehicle accident: ( ) YES ( ) NO If yes when: ______________________ Explain accident: ___________________ ____________________________________________________________________ Have you ever been convicted of a felony: ( ) YES ( ) NO If yes when: ________________________ In what state: ______________________ Describe the felony: _____________________________________________________ POSITION APPLYING FOR: ________________________________________________ Are you employed now: _____ If yes may we contact your present employer: _______ Have you ever applied to this company before: ________ If so when: ______________
# Years Did
You Elementary School High School College Trade School Other Have you ever served in the U.S. military: ______ Branch: ________ Dates: __________ Type of Discharge: __________ Currently serving in National Guard or Reserves: ______ Subjects of special study or other relevant experience: ___________________________ _______________________________________________________________________ EXPERIENCE (List most recent employer first) (1) Dates Employed: From ____________________ to _______________________ Name of Company: ___________________________________ Salary:_____________ Address: ___________________________________ Telephone: ( ) _____________ Position Held: ___________________________ Supervisor: _____________________ Duties Performed: ________________________________________________________ ________________________________________________________ ________________________________________________________ Reason for Termination:____________________________________________________ -------------------------------------------------------------------------------------------- (2) Dates Employed: From ____________________ to ______________________ Name of Company: __________________________________ Salary: _____________ Address: ___________________________________ Telephone: ( ) _____________ Position Held: ________________________ Supervisor: ________________________ Duties Performed: ________________________________________________________ ________________________________________________________ ________________________________________________________ Reason for Termination: ____________________________________________________ -------------------------------------------------------------------------------------------- (3) Dates Employed: From ____________________ to ______________________ Name of Company: _____________________________________ Salary: ___________ Address: _____________________________________ Telephone: ( ) ___________ Position Held: _________________________ Supervisor: _______________________ Duties Performed: ________________________________________________________ ________________________________________________________ Reason for Termination: ____________________________________________________ -------------------------------------------------------------------------------------------- REFERENCES Please give the names of three (3) persons Not
Related To You, whom you have known ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ PHYSICAL RECORD Do you have any physical limitations that preclude you
from performing any work for If yes, please describe: ___________________________________________________ _____________________________________________________________________ In case of an emergency, who should we contact: NAME: ________________ ADDRESS: ______________________ TELE: ___________ Will you consent to: A Drug Test ( )YES ( )NO A Physical Examination ( ) YES ( ) NO “ I
certify that the facts contained in this application are true and complete to
the I
authorize investigation of all statements contained herein and the references NAME: ____________________________________ DATE: _____________________ SIGNATURE: ___________________________________________ ( Please feel free to attach your resume) |
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GuyHKWD@comcast.net with
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