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Personal Information

Last Name*
First Name*
Middle Name
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
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If employed and you are under 18, can you furnish a work permit?
1. Yes
1. No
Do you have a current, valid driver's license?*
1. Yes
1. No
List professional trade, business, or civic activities and offices held. (You may exclude those which indicate a protected class):
Summarize any additional special skills and qualifications acquired from employement of other experience that you feel may be helpful in considering your application:
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Water Works Experience:
Water Works Education:
Filtration Plant Employement:
Name of Plant
Type of Plant
MGD of Plant
How Long at Plant?
Current Water Treatment Operator's Certification:
Operator Grade
Date Issued
Issuing Agency
Current Water Distribution Operator's Certification:
Operator Grade
Date Issued
Issuing Agency
Can you operate a Backhoe?
1. never tried
2. moderately well
3. proficient
If yes, what type of backhoe
What type of construction or plumbing work have you performed and what equipment have you operated?
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Please provide the name, address and telephone number of three personal references that are not related to you and are not previous employers.
Full Name*
Relationship*
Phone Number*
Full Name*
Relationship*
Phone Number*
Full Name*
Relationship*
Phone Number*
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I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*

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