Please fill in the following as completely as possible Employment Desired Position Applying For * Type of Work I'm applying for regular, full-time work I'm applying for temporary/seasonal work If applying for temporary/seasonal work Days available to work During what period of time will you be available? For example, from 8 a.m. to noon. Available for work on weekends? Yes No Are you younger than 18 years of age? Yes No Personal Information First Name * Middle Initial Last Name * Mailing Address Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code * Physical Address Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code Email address * Phone number * Employment HistoryFailure to complete this section may result in disqualification. A resume is not a substitute for completing the Employment History section. Substantial gaps in employment should be explained. List all jobs you have held in the past 10 years. PUT YOUR PRESENT OR MOST RECENT JOB FIRST. Include military service. By being thorough you may improve your chances for employment. If you need more space you may attach additional sheets. You must include number of hours worked each week. Job 1 From Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028 To Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028 Total Years Full Time or Part Time? - None -Full TimePart Time Employer's Name Job Title and Duties Employer's Address Supervisor Phone Number Reason for Leaving May we contact this employer for a reference? Yes No Job 2 From Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028 To Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028 Total Years Full Time or Part Time? - None -Full TimePart Time Employer's Name Job Title and Duties Employer's Address Supervisor Phone Number Reason for Leaving May we contact this employer for a reference? Yes No Job 3 From Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028 To Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028 Total Years Full Time or Part Time? - None -Full TimePart Time Employer's Name Job Title and Duties Employer's Address Supervisor Phone Number Reason for Leaving May we contact this employer for a reference? Yes No Job 4 From Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028 To Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028 Total Years Full Time or Part Time? - None -Full TimePart Time Employer's Name Job Title and Duties Employer's Address Supervisor Phone Number Reason for Leaving May we contact this employer for a reference? Yes No Education Do you have a high school diploma or G.E.D.? - None -YesNo Name of High School Do you have an AA/AS degree? - None -YesNo Do you have a BA/BS degree? - None -YesNo Do you have a post graduate degree? - None -YesNo College/University/Trade SchoolNOT high school Name of institution Course or major Hours or units completed Did you graduate? - None -YesNo Degree received College/University/Trade SchoolNOT high school Name of institution Course or major Hours or units completed Did you graduate? - None -YesNo Degree received College/University/Trade SchoolNOT high school Name of institution Course or major Hours or units completed Did you graduate? - None -YesNo Degree received College/University/Trade SchoolNOT high school Name of institution Course or major Hours or units completed Did you graduate? - None -YesNo Degree received Licenses and CertificationsList Licenses or Professional Certifications/Registrations Relevant to This Position: Details Type State Class Number Expiration Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2021202220232024202520262027202820292030203120322033 Details Type State Class Number Expiration Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2021202220232024202520262027202820292030203120322033 Details Type State Class Number Expiration Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2021202220232024202520262027202820292030203120322033 Has your license/certification ever been revoked or suspended? - None -YesNo If yes, state reason(s), date of revocation or suspension, and date of reinstatement. Do You Have a Valid Driver’s License? - None -YesNo A current DMV report showing an acceptable driving record will be required after job offer and prior to employment. Other Personal Information Do you have any relatives working for the District? - None -YesNo If yes, please identify: Name Relationship Department If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? - None -YesNo Have you been given a copy of the Job Description which outlines the essential functions of the job for which you are applying? - None -YesNo Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? - None -YesNo If no, describe the functions that cannot be performed. If you become a finalist for the position, do you have any objection to a representative of the District making inquiry of your present employer regarding your background and qualifications? - None -YesNo If yes, state reason: If now employed, why do you want to leave? Please provide in this space: 1) Any additional information you would like to have the District consider, 2) Any substantial gap in your employment history, and further explanation to any “yes” response: How did you hear about this job? - None -NewspaperEmployeeCraigslistFacebookInstagramNextDoorNTPUD publication or websiteZip Recruiter/Indeed/Jobs AvailableLinkedInOther (Please Specify) Please specify I HEREBY CERTIFY that the foregoing statements are true and accurate to the best of my knowledge and belief. I agree and understand that any misstatement of material fact contained in this application may cause me to forfeit all rights to employment with the District. Employment offer may be contingent on passing a job-related physical examination, drug test, and fingerprint background check. Yes, I agree to these terms. Yes, I agree to these terms.
