Employment Application Form - Westlands Water District

HR Date Recieved

MM slash DD slash YYYY

Completely fill out application and sign it. It is the applicant’s responsibility to ensure that the application is on file in Human Resources on the final filing date. Resumes are not acceptable in lieu of an application. Late applications will be rejected.

Position Applying for:(Required)

The deadline for submitting an application for this opening has passed.

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Main Phone(Required)

Work Phone

Cell Phone

Completion of the following four questions are required only if the position for which you are applying requires the possession of a valid California’s Driver’s License

DL #

DL Class

DL State

DL Expiration Date

MM slash DD slash YYYY

Did you pass High School, pass the State High School Equivalency Exam, or do you possess a G.E.D. certificate?(Required)

Yes

Name of College or University

Major

Degree/Certificate

Units Completed

Name of College or University

Major

Degree/Certificate

Units Completed

Are you now or have you ever been employed with the District?(Required)

Yes

What dates were you employed with the District? And what was your position with the District?

Are you related by blood or marriage to any person(s) presently employed with the District?(Required)

Yes

Employee 1 Name

Relationship to Employee 1

Employee 2 Name

Relationship to Employee 2

Have you ever been discharged from employment or been forced to resign?(Required)

Yes

If yes, give details

If hired, can you provide proof of the legal right to work in the United States?(Required)

Yes

Having read the job announcement which lists examples of job duties for the position, are you able to perform these duties with or without accomodation?

Yes

Have you ever worked under or been known by another name?(Required)

Yes

Alternative Name #1

Dates you used this name

Alternative Name #2

Dates you used this name

Bilingual Skill: What language(s) do you fluently speak, read and write other than English?

Do you qualify for credits based on U.S. Military Service?(Required)

If yes, submission of honorable wartime service, DD214 must be received with application.

Yes

Please Read Carefully

A resume is not acceptable in place of completing the following.
Show your present or most recent job first.
Show all employment during the past 10 years (or more, if qualifying Experience).
Use a separate block for each Job Title (even those with same employer).
Remember your acceptance depends on the completeness and accuracy of the information that is provided on this application.

Important: To receive appropriate credit for work experience, date of employment must include month, day, and year.

Special Licenses, Certificate, or Registration Requirements

Fill in this section only if license(s) etc., are required for this job. Include title, date issued, date expires, serial number, and which state and/or agency issued it.

Job Title

Describe your duties fully:

Reason for Leaving

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

# of Hours worked weekly

Organization Name and Address

Supervisor and Phone Number

May we contact?

Yes

Job Title

Describe your duties fully:

Reason for Leaving

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

# of Hours worked weekly

Organization Name and Address

Supervisor and Phone Number

May we contact?

Yes

Job Title

Describe your duties fully:

Reason for Leaving

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

# of Hours worked weekly

Organization Name and Address

Supervisor and Phone Number

May we contact?

Yes

Job Title

Describe your duties fully:

Reason for Leaving

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

# of Hours worked weekly

Organization Name and Address

Supervisor and Phone Number

May we contact?

Yes

Job Title

Describe your duties fully:

Reason for Leaving

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

# of Hours worked weekly

Organization Name and Address

Supervisor and Phone Number

May we contact?

Yes

Please identify and explain all periods of unemployment in excess of one month during the past 10 years:

Reason

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

Reason

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

Reason

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

Signature(Required)

Date(Required)

MM slash DD slash YYYY

The following information is requested to assist in implementing the District’s Affirmative Action and Equal Employment Opportunity policy and state and federal requirements. Submission of this information is strictly voluntary and will NOT be retained with your application but handled separately and confidentially for statistical purposes.

How did you learn of this job opening?

Newspaper Ad

Internet

Trade Publication

WWD Job Interest Card

WWD Employee

Other

Name of Newspaper Publication

Name of Site

Name of Trade Publication

Please describe

Gender

Female

Male

Age

Under 40

40 or over

Accommodations Needed

I can perform the essential functions of the position WITHOUT reasonable accommodations.

I can perform the essential functions of the position WITH reasonable accommodations.

Please describe the type of assistance or accommodations needed:

Disability: A person with a disability is an individual who:(1) has a physical or mental impairment or medical condition that limits one or more life activities, such as walking, speaking, breathing, performing manual tasks, seeing, hearing, learning, caring for oneself or working; (2) has a record or history of such impairment or medical condition; or (3) is regarded as having such an impairment or medical condition.

I have a disability

I have a disability which meets the definition above

Ethnic Affiliation

White – All persons having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American – All persons having origins in any of the black racial groups of Africa.

Hispanic – All persons of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture, or origin, regardless of race.

Not Hispanic or Latino

Native Hawaiian or Other Pacific Islander – All Persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian – All persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, or Vietnam.

American Indian or Alaskan Native – All Persons having origins in any of the original peoples of North or South America (including Central America), and who maintains tribal affiliation or community attachment.

Phone

This field is for validation purposes and should be left unchanged.