Employment - Lancaster Water Group

Applicant Information

Name*

First Middle Initial Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Position you are applying for:*

Date Available to Start*

SSN*

Desired Annual Salary*

Are you a US citizen?*

Yes

No

Are you authorized to work in the US?*

Yes

No

Have you ever worked for our company before?*

Yes

No

When did you work for us?*

Have you ever been convicted of a felony?*

Yes

No

Explain your felony:*

Education Part 1: High School

Name of High School*

Address of High School*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Year Started*

Year Completed*

Did you graduate?*

Yes

No

Degree Received*

Education Part 2: College

Name of College

Address of College

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Year Started

Year Completed

Did you graduate?

Yes

No

Degree Received

Education Part 3: Further Education / Other

Name of College / Program

Address of College / Program

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Degree Received

Year Started

Year Completed

Did you graduate?

Yes

No

Previous Employment #1

Company

Company Phone

Supervisor

First Last

May we contact your supervisor for referenec?

Yes

No

Job Title

Responsibilities

Date Started

Date Ended

Starting Salary

Ending Salary

Reason for leaving

Previous Employment #2

Company

Company Phone

Supervisor

First Last

May we contact your supervisor for referenec?

Yes

No

Job Title

Responsibilities

Date Started

Date Ended

Starting Salary

Ending Salary

Reason for leaving

Previous Employment #3

Company

Company Phone

Supervisor

First Last

May we contact your supervisor for referenec?

Yes

No

Job Title

Responsibilities

Date Started

Date Ended

Starting Salary

Ending Salary

Reason for leaving

Military Service

Branch

Start Date

End Date

Rank at Discharge

Type of Discharge

If other than honorable, explain:

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 release.

Signature*

Employment Application

Applicant Information

Education Part 1: High School

Education Part 2: College

Education Part 3: Further Education / Other

Previous Employment #1

Previous Employment #2

Previous Employment #3

Military Service

Disclaimer and Signature

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