MVSD Employment Application

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MVSD Employment Application

Mt. View Sanitary District is an Equal Opportunity Employer

Date (required)

Attach Cover Letter

Name (Last, First, Middle) (required)

Home Telephone (required)

Business Telephone

Present Address (#, Street, City, State, Zip) (required)

Permanent Address (if different from present address)

EMPLOYMENT DESIRED

Position applying for (required)

Type of work (required)

Regular full-time work

Regular part-time work

Temporary work, e.g., summer or holiday work

What days and hours are you available for work? (required)

If applying for temporary work, during what period of time will you be available?

Are you available for work on weekends? (required)

Yes

Would you be available to work overtime, if necessary? (required)

Yes

If hired, on what date can you start work? (required)

Salary desired (required)

PERSONAL INFORMATION

Have you ever applied to or worked for Mt. View Sanitary District before? (required)

Yes

If yes, when?

Do you have any friends or relatives working for Mt. View Sanitary District? (required)

Yes

If yes, state name(s) and relationship

Why are you applying for work at Mt. View Sanitary District? (required)

If hired, would you have a reliable means of transportation to and from work? (required)

Yes

Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.) (required)

Yes

If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? (required)

Yes

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? (Note: MVSD complies with the ADA and will consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire will be subject to passing a medical examination, and to skill and agility tests.) (required)

Yes

If no, describe the functions that cannot be performed

EDUCATION, TRAINING & EXPERIENCE

High School (Name & Address)

Did you graduate?

Yes

Degree or Diploma

College/University (Name & Address)

No. of Years Completed

Did you graduate?

Yes

Degree or Certificate

Vocational/Business (Name & Address)

No. of Years Completed

Did you graduate?

Yes

Degree or Certificate

Do you have any other experience, training, qualifications, or skills which you feel make you especially suited for work at Mt. View Sanitary District? If so please explain.

Are you licensed/certified for the job applied for?

Yes

Name of license/certification

Issuing Agency

License/certification number

Has your license/certification ever been revoked or suspended?

Yes

If yes, state reasons(s), date of revocation or suspension, and date of reinstatement

Attach pertinent state certification(s) and/or licenses

EMPLOYMENT HISTORY- List below all present and past employment starting with your most recent employer (last 10 years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.

Name of Employer

Address (#, Street, City, State, Zip)

Type of Business

Telephone No.

Supervisor's Name

Your Position & Duties

Date of Employment (From - To)

Reason for leaving

Name of Employer

Address (#, Street, City, State, Zip)

Type of Business

Telephone No.

Supervisor's Name

Your Position & Duties

Date of Employment (From - To)

Reason for Leaving

Name of Employer

Address (#, Street, City, State, Zip)

Type of Business

Telephone No.

Supervisor's Name

Your Position & Duties

Date of Employment (From - To)

Reasons for Leaving

Name of Employer

Address (#, Street, City, State, Zip)

Type of Business

Telephone No.

Supervisor's Name

Your Position & Duties

Date of Employment (From - To)

Reasons for Leaving

Additional Employment History or Resume

PLEASE READ CAREFULLY & INITAL AFTER EACH PARAGRAPH

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. (required)

I understand that if I am qualified for employment I must pass a job related physical examination and may be required to answer questions regarding past criminal convictions, if any. (required)

I understand that if I am qualified for employment, offers of employment are contingent upon passing a pre-employment drug screening examination showing fitness for District work and a pre-employment evaluation to determine my ability to perform job-related functions. This exam is consistent with the District’s Drug and Alcohol-free Workplace Policy. (required)

I understand that nothing contained in the application or conveyed during any interview that may be granted or during my employment, if hired, is intended to create an employment contract between me and the Mt. View Sanitary District. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Mt. View Sanitary District, and that no promises or representations contrary to the foregoing are binding on the Mt. View Sanitary District unless made in writing and signed by me and the Mt. View Sanitary District’s designated representative. (required)

Signature Date (required)

Signature (type /S/ then name): /S/ (required)

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3800 Arthur Road, Martinez CA 94553

Telephone (925) 228-5635

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