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)
Position applying for (required)
What days and hours are you available for work? (required)
If applying for temporary work, during what period of time will you be available?
If hired, on what date can you start work? (required)
Salary desired (required)
If yes, when?
If yes, state name(s) and relationship
Why are you applying for work at Mt. View Sanitary District? (required)
If no, describe the functions that cannot be performed
High School (Name & Address)
Degree or Diploma
College/University (Name & Address)
No. of Years Completed
Degree or Certificate
Vocational/Business (Name & Address)
No. of Years Completed
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.
Name of license/certification
Issuing Agency
License/certification number
If yes, state reasons(s), date of revocation or suspension, and date of reinstatement
Attach pertinent state certification(s) and/or licenses
Attach pertinent state certification(s) and/or licenses
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
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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