Clifton Park Water Authority

Applicant Information

Full Name (Last, First, M.I.):*

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State:*

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Zip Code:*

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Email:*

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Date Available:*

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Desired Salary:*

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Position Applied for:*

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Are you a citizen of the United States?*

YESNO

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If no, are you authorized to work in the U.S.?

YESNO

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Have you ever worked for this company?*

YESNO

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If yes, when?

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Have you ever been convicted of a felony?*

YESNO

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If yes, explain:

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Education

High School:*

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Address:*

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From:*

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Did you graduate?*

YESNO

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To:*

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Diploma:

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College:

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From:

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Did you graduate?

YESNO

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To:

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Degree:

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Other:

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Address:

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From:

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Did you graduate?

YESNO

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To:

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Degree:

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References

Please list three professional references.

Full Name:

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Previous Employment

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Supervisor:

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Job Title

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Starting Salary:

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Ending Salary:

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Responsibilities:

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Reason for Leaving:

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May we contact your previous supervisor for a reference?

YESNO

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Reason for Leaving:

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May we contact your previous supervisor for a reference?

YESNO

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Company:

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Job Title

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Ending Salary:

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Reason for Leaving:

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May we contact your previous supervisor for a reference?

YESNO

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Military Service

Branch:

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Rank at Discharge

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Type of Discharge:

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If other than honorable, explain:

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Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature (Please type in full name):*

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Date:

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Resume:

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*

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Employment Application