Form Center

Step One

Equal Employment Opportunity
It is our policy to seek and employ the best qualified personnel and individuals that best match the positions, to provide equal opportunity for the advancement of employees and to administer all of our personnel policies in a manner that will not discriminate against any person because of race, color, religion, age, sex, marital or veteran status, natural origin, ancestry, disability, on-the-job injuries, or any other legally protected status unless it is a bonafied occupational requirement reasonably necessary to the operation of our business.
Important Information
Applicants with disabilities may request any reasonable accommodation necessary to complete this application, or to take any test required for the position for which the applicant has applied, by making a request at the time of application.
Instructions
The information you provide will be reviewed against the essential qualifications of the open position(s). Please read carefully and complete. This application must be completed in full. Provide all information requested.
Position Being Applied For*
First Name*
Middle Name*
Last Name*
Address*
City*
State*
Zipcode*
Telephone Number*
Alternate Contact Number (specify)
Email Address*
Are you 18 years of age or older?*
1. Yes
1. No
Do you have any relatives working for CDID#1?*
1. Yes
1. No
Have you ever worked for us before?*
1. Yes
1. No
If yes, when?
If yes, when? Start Date
—
If yes, when? End Date
If hired, are you prepared to present evidence within three business days of starting work showing you are legally authorized to work in the United States?*
1. Yes
1. No
Can you travel if the job duties require it or for training purposes?*
1. Yes
1. No
Check all shifts you can work:*
1. Full Time
2. Part Time
3. Rotating Days Off
4. Days
1. Swing
2. Graveyard
3. Rotating Shifts
Check all days you can work:*
1. Monday
2. Tuesday
3. Wednesday
4. Thursday
1. Friday
2. Saturday
3. Sunday
Accommodations
We will attempt to reasonably accommodate employees who require certain hours or days off because of religious beliefs or practices.
Date Available to Start Employment*
Date Available to Start Employment
Expected Rate of Pay*
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Education

Experience

Work Experience
List your work and/or volunteer experience with emphasis on experience that is relevant to the position you are applying for. Begin with your present or most recent experience. Include full-time, part-time and temporary employment. Include military service that would help you qualify. List each promotion as a separate position. Explain employment gaps longer than one month. This information must be completed even if you submit a resume.
Name of Employer
Employer Address
Your Job Title
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Type of Business
Average Hours Per Week
Immediate Supervisor
Supervisor Phone Number
May We Contact Employer?
1. Yes
1. No
Describe Your Duties in Detail
List any knowledge, skills, behaviors required, employees supervisors and accomplishments.
Reason for Leaving
Name of Employer
Employer Address
Your Job Title
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Type of Business
Average Hours Per Week
Immediate Supervisor
Supervisor Phone Number
May We Contact Employer?
1. Yes
1. No
Describe Your Duties in Detail
List any knowledge, skills, behaviors required, employees supervisors and accomplishments.
Reason for Leaving
Name of Employer
Employer Address
Your Job Title
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Type of Business
Average Hours Per Week
Immediate Supervisor
Supervisor Phone Number
May We Contact Employer?
1. Yes
1. No
Describe Your Duties in Detail
List any knowledge, skills, behaviors required, employees supervisors and accomplishments.
Reason for Leaving
Name of Employer
Employer Address
Your Job Title
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Type of Business
Average Hours Per Week
Immediate Supervisor
Supervisor Phone Number
May We Contact Employer?
1. Yes
1. No
Describe Your Duties in Detail
List any knowledge, skills, behaviors required, employees supervisors and accomplishments.
Reason for Leaving
Other Qualifications
List any other skills or qualification you believe are relevant to the position you are applying for.
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Verification and Signature

Verification and Signature
1. I authorize the investigation of all matters which CDID#1 deems relevant to my qualifications for employment, including all information given in this application and in any attachments, supporting documents or interviews. I authorize you to request and receive such information and I release from all liability any current or forms employers, other entities (schools, etc.), or persons (such as current or former supervisors, co-workers, etc.), supplying it. I also release you from all liability which might result from making the investigation.

2. I certify all the information given in this application and in any attachments, supporting documents or interview are (or will be) true and complete to the best of my knowledge. I understand that any falsification, misrepresentation or representation, as well as any misleading statements or omissions, generally will result in denial of employment, withdrawal of any offer of employment, or immediate termination, regardless of when or how discovered.

3. I understand I may be required to submit pre- or post- employment physical or other professional examinations, medical inquiries and/or urinalysis tests for the presence of drugs and/or alcohol. I agree to such examinations, inquiries and/or testing at CDID#1 expense. I authorize release of the results to CDID#1 and their use to evaluate my suitability for employment. I also release CDID#1 from all liability arising out of or connected with any examinations, inquiries and/or testing.

4. I understand that I may resign or be terminated without cause or notice, at any time, unless otherwise stated in a written employment contract. I also understand only the Board of Supervisors has the authority to agree to any other terms and/or enter into such contracts, and that any such agreements for terms of employment or contracts must be in writing and signed by both parties. I also understand unless otherwise stated in a written employment contract that CDID#1 may change, withdraw and interpret other policies (including wages, hours and working conditions) as it deems appropriate.

5. This application will only be considered for this position and this job/opening announcement, unless otherwise notified by CDID#1.

6. I understand and agree that if I am hired the statements in these paragraph will become a binding part of my employment relationship. I have read each of these statements and reviewed all the information provided in this application and in any attachments or supporting documents.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your 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.
1. I agree.
Electronic Signature*
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For CDID#1 Use Only

Job Title
Department
Position Number
Date Employed
Date Employed
Hourly Rate/Salary
Elected Official/District Manager Approval Signature
Notes

Leave This Blank:

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

This field is not part of the form submission.
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Employment Application

Steps

Step One

Education

Experience

Verification and Signature

For CDID#1 Use Only