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BWA Employment Application

2. Benbrook Water Authority Application for Employment

4. Name*

5. Email Address*

7. Address*

9. City*

10. State*

11. Zip Code*

13. Phone Number*

15. Position Applied For:*

17. Are you legally eligible for employment in the United States?*

    1. Yes

    1. No

    If yes, proof is required if hired.

19. Shift Preferred*

    1. 1st
    2. 2nd
    3. 3rd

    Please select which shift(s) you are willing to work

21. Expected Pay

23. Will you accept:*

    1. Full-Time Work

    1. Part-Time Work

25. On what date would you be available for work?*

27. Have you ever been employed here?*

    1. Yes

    1. No

29. If so, please give dates

31. Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)?*

    1. Yes
    2. No
    3. Need more information about the job's essential functions to respond.

    This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

33. Explain any gaps in your employment, other than those due to personal illness, injury or disability.

35. Have you ever been fired or asked to resign from a job?*

    1. Yes

    1. No

37. If yes, please explain.

39. Please list special training or skills (languages, machine operation, etc.) that would be of benefit in the job for which you are applying.

43. EMPLOYMENT EXPERIENCE
    Please list your most recent employer first.

    Please list your most recent employer first.

45. Employer*

46. Employer Contact*

48. Address*

49. Phone*

51. Job Title*

52. Supervisor

54. Dates Employed:

55. From*
    From

56. To*
    To

58. Starting Salary:

59. Ending Salary

61. Work Performed*

63. Reason for Leaving*

65. May we contact this employer?*

    1. Yes

    1. No

69. Employer

70. Employer Contact

72. Address

73. Phone

75. Job Title

76. Supervisor

78. Dates Employed:

79. From
    From

80. To
    To

82. Starting Salary:

83. Ending Salary

85. Work Performed

87. Reason for Leaving

89. May we contact this employer?

    1. Yes

    1. No

93. Employer

94. Employer Contact

96. Address

97. Phone

99. Job Title

100. Supervisor

102. Dates Employed:

103. From
     From

104. To
     To

106. Starting Salary:

107. Ending Salary

109. Work Performed

111. Reason for Leaving

113. May we contact this employer?

     1. Yes

     1. No

117. Employer

118. Employer Contact

120. Address

121. Phone

123. Job Title

124. Supervisor

126. Dates Employed:

127. From
     From

128. To
     To

130. Starting Salary:

131. Ending Salary

133. Work Performed

135. Reason for Leaving

137. May we contact this employer?

     1. Yes

     1. No

141. EDUCATION

143. High School*

144. Did you graduate?*

     1. Yes
     2. No

145. Course of Study

149. College

150. Course of Study

152. Did you graduate?

     1. Yes
     2. No

153. Degree

157. Graduate School

158. Course of Study

160. Did you graduate?

     1. Yes
     2. No

161. Degree

165. Vocational Training/Other

166. Course of Study

168. Did you graduate?

     1. Yes
     2. No

169. Degree or Diploma

173. Do you want to attach a resume?*

     1. Yes
     2. No

175. Upload Resume

179. ACKNOWLEDGEMENT
     I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from employment with the Benbrook Water Authority whenever it is discovered. I give the Benbrook Water Authority the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the Benbrook Water Authority and its representatives for seeking, gathering, and using such information and all other persons, corporations, or organizations for furnishing such information. The Benbrook Water Authority does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state, or federal law. The Benbrook Water Authority only considers tobacco-free candidates for employment. I acknowledge that this application, once submitted to the Benbrook Water Authority, becomes the property of the Benbrook Water Authority. I acknowledge that any offer of employment will be contingent on my satisfactory completion of a criminal background screening and a drug screening. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the Benbrook Water Authority reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the Benbrook Water Authority, other than an authorized officer, has the authority to make any assurances to the contrary. I furher understand that any such assurances must be in writing and signed by an authorized officer. I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization. I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

     I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from employment with the Benbrook Water Authority whenever it is discovered. I give the Benbrook Water Authority the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the Benbrook Water Authority and its representatives for seeking, gathering, and using such information and all other persons, corporations, or organizations for furnishing such information. The Benbrook Water Authority does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state, or federal law. The Benbrook Water Authority only considers tobacco-free candidates for employment. I acknowledge that this application, once submitted to the Benbrook Water Authority, becomes the property of the Benbrook Water Authority. I acknowledge that any offer of employment will be contingent on my satisfactory completion of a criminal background screening and a drug screening. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the Benbrook Water Authority reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the Benbrook Water Authority, other than an authorized officer, has the authority to make any assurances to the contrary. I furher understand that any such assurances must be in writing and signed by an authorized officer. I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization. I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

181. Electronic Signature Acknowledgement*

     1. I agree

     By checking the "I agree" box above, you agree and acknowledge that 1) your employment application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

183. Electronic Signature*

Leave This Blank:


185. 1. Receive an email copy of this form.
186. Email address

     This field is not part of the form submission.

187. Submit Submit and Print

* indicates a required field