JCWSD Online Employment Application Name(Required) First Name Middle Initial Last Name Address(Required) Street Address Apt/Suite/Unit# City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Are you a United States Citizen?(Required) Yes No If No, are you authorized to work in the U.S.? Yes No Have you ever worked for us in the past?(Required) Yes No When did you work for us? (Approximate Dates)Have you ever been convicted of a Felony?(Required) Yes No Please explain with general details EDUCATION HISTORYHigh School DetailsHigh School NameAddressAttended From Month Day Year Attended To Month Day Year Did you Graduate? Yes No Degree EarnedAdditional Education Received? Yes No College DetailsCollege NameAddressAttended From Month Day Year Attended To Month Day Year Did you Graduate? Yes No Degree EarnedOther Education Received? Yes No Other Education DetailsSchool NameAddressAttended From Month Day Year Attended To Month Day Year Did you Graduate? Yes No Degree Earned ReferencesPlease list three professional referencesReference #1 Full NameRelationshipCompany NameAddressPhoneReference #2 Full NameRelationshipCompany NameAddressPhoneReference #3 Full NameRelationshipCompany NameAddressPhone Previous Employment Employer #1CompanyPhoneAddressSupervisor's NameJob TitleStarting SalaryEnding SalaryResponsibilitiesFrom (Date)To (Date)Reason for Leaving?May we contact your previous supervisor for a reference? Yes No Employer #2CompanyPhoneAddressSupervisor's NameJob TitleStarting SalaryEnding SalaryResponsibilitiesFrom (Date)To (Date)Reason for Leaving?May we contact your previous supervisor for a reference? Yes No Employer #3CompanyPhoneAddressSupervisor's NameJob TitleStarting SalaryEnding SalaryResponsibilitiesFrom (Date)To (Date)Reason for Leaving?May we contact your previous supervisor for a reference? Yes No Military ServiceMilitary BranchAir ForceArmyCoast GuardMarine CorpNavyFrom (date)To (date)Rank at DischargeWere you Honorably Discharged? Yes No Please explain why you were not honorably discharged Disclaimer and SignatureRead each paragraph carefully. Indicate your understanding of, and consent to, the contents and condition of each by checking the box at the beginning of each paragraph.Consent #1(Required) I agree to statement below.I understand and accept that if I am selected for employment, my employment may be conditional upon my passing any medical examination that the Employer deems necessary to determine within reasonable accommodation. I understand and accept that this may include drug, alcohol, or substance abuse testing.Consent #2(Required) I agree to statement below.I understand and accept that given the duties and responsibilities of the Employer, I may be required to work weekends, evening hours, or at other times as determined by the Employer, including overtime hours. Consent #3(Required) I agree to statement below.I understand and accept that it may be necessary for me to sign any waivers necessary to allow the Employer to obtain information from my current and former employers, schools, and personal references.Consent #4(Required) I agree to statement below.I understand and accept that if any information required in this application is found to be falsified or intentionally excluded, my application may be disqualified from further consideration. I further understand and accept that, if I am employed by the Employer, I may be subject to disciplinary action, including termination, if any information required by this application is falsified or intentionally excluded.Signature(Required)I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.This field is hidden when viewing the formDate(Required) MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. Employment Links Application for Employment Operations Supervisor Job Advertisement WWTP Operator Job Advertisement
