EmailMe Form - CCW Meter Reader Employment Application

Position Applied For

Date

MM / DD / YYYY

When will you be available for employment?

Are you seeking:

Full-time

Part-time

Summer Work

Name *

First Middle Last

Email *

Address *

Street Address City State / Province / Region Postal / Zip Code

Phone *

### - ### - ####

Secondary Phone

### - ### - ####

GENERAL INFORMATION

Have you ever been employed with Cleveland County Water?

Yes

No

If yes, what department and when?

Are you related by blood or marriage to any CCW employee or Commissioner?

Yes

No

If yes, give name, relationship, and department

Were/Are you a member of the U.S. Armed Forces?

Yes

No

If yes, give the branch and dates of service

Have you ever been convicted of or plead guilty to a crime?

Yes

No

If yes, please explain each conviction, nature of offense, date(s) of conviction, sentence, and type(s) of rehabilitation, if any. Please include any major traffic violations.

NOTE: A conviction will not automatically bar you from employment.

EDUCATION

(Give complete education history below)

High School Name:

Location

Highest School Year Completed:

If you did not graduate, do you have a High School Equivalency (GED)?

Yes

No

Education Beyond High School

	Name and Location	# Years Completed	Degree/Certificate	Major Subject
College or University
Graduate or Professional
Other Education

SKILLS AND CERTIFICATIONS

Professional License and/or Certifications Special Training

Equipment Skills

Computer or Other Skills

EMPLOYMENT

Record your complete work history in the spaces below. Begin with your current or most recent employer first. Attach as many sheets as is necessary to account for your full record. Be sure to account for gaps in your employment history. Please complete the employment history information even if a resume is attached. Related volunteer experience should also be listed.

A. CURRENT OR MOST RECENT EMPLOYMENT

Employer or Company

Job Title

Starting Salary

Last Salary

Name and Title of Supervisor

Number of employees you supervise

Phone

### - ### - ####

Address

Street Address City State / Province / Region Postal / Zip Code

Date Employed

MM / DD / YYYY

Date Separated

MM / DD / YYYY

Main Duties

Full-time Years and Months

Part-time Years and Months

Reason for Leaving

If part-time, number of hours worked per week

If currently employed, may we inquire of this employer about your qualifications and character?

Yes

No

B. NEXT MOST RECENT EMPLOYER

Employer or Company

Job Title

Starting Salary

Last Salary

Name and Title of Supervisor

Number of employees you supervise

Phone

### - ### - ####

Address

Street Address City State / Province / Region Postal / Zip Code

Date Employed

MM / DD / YYYY

Date Separated

MM / DD / YYYY

Main Duties

Full-time Years and Months

Part-time Years and Months

Reason for Leaving

If part-time, number of hours worked per week

C. NEXT RECENT EMPLOYMENT

Employer or Company

Job Title

Starting Salary

Last Salary

Name and Title of Supervisor

Number of Employees you supervise

Phone

### - ### - ####

Address

Street Address City State / Province / Region Postal / Zip Code

Date Employed

MM / DD / YYYY

Date Separated

MM / DD / YYYY

Main Duties

Full-time Years and Months

Part-time Years and Months

Reason for Leaving

If part-time, number of hours worked per week

REFERENCES

List three (3) persons who are not related to you and who have a definite knowledge of your ability to perform the job for which you are applying. DO NOT REPEAT NAMES OF SUPERVISORS

Name

First Last

Phone

### - ### - ####

Address

Street Address City State / Province / Region Postal / Zip Code

Name

First Last

Phone

### - ### - ####

Address

Street Address City State / Province / Region Postal / Zip Code

Name

First Last

Phone

### - ### - ####

Address

Street Address City State / Province / Region Postal / Zip Code

SIGNATURE - Read Carefully before submitting

Clear

I certify that all answers and statements on this application are true and complete. I understand that any falsification, omission, or misrepresentation of facts in this application, in connection with my pre-employment physical examination or in connection with any aspect of the hiring process, will be cause for either the rejection of this application or for my discharge if I have been hired.

I understand that my employment will be contingent upon my passing a physical examination. I also understand that future examinations may be required by Cleveland County Water. I am aware that Cleveland County Water requires screening for drugs and alcohol as part of its pre-employment testing and that I may be required to take future examinations.

I authorize Cleveland County Water to make any inquiry or investigation deemed necessary to consider my employment application. This may include contacting former employers and criminal records check. I understand that conviction of a crime will not automatically bar my employment. I may still be eligible for employment if Cleveland County Water determines my conviction could have no bearing to the job for which I am applying.

I authorize former employers and schools to release all information Cleveland County Water requests from them concerning my academic records, job performance, attendance, personal evaluation, or other related information. I release from liability and /or damages all parties which may give information regarding my application.

If my employment with Cleveland County Water terminates for any reason, I authorize Cleveland County Water to release all information and to answer any inquiries regarding my employment, performance, and the reasons for my termination.

I understand that if I am employed my employment will be on a trial basis for 6 months. Before and after the probationary period my employment is “at will;” It can be terminated at any time by me or Cleveland County Water. I also understand that the terms, policies, procedures, and rules of employment are not guaranteed. They are subject to change at any time by Cleveland County Water.

Although I may be employed for a specific work schedule, I understand Cleveland County Water does not guarantee my work schedule and may alter it as necessary.

I understand this application is current for only the specified job I am applying for. I will complete a new application should I not be hired for the applied for position if future job opportunities become available that I may be interested in.