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2. P.O. Box 1390 Woodinville, WA 98072 Phone: 425-487-4100 Email: jobs@woodinvillewater.com
4. Name*
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone*
15. Position Applied For
    -- Select One --Seasonal Maintenance Worker
17. If you have lived at this address for less than five years, please attach a listing of all addresses for the past five years. Additionally, attach Resume, Cover Letter, and other documents you want us to see.
19. Woodinville Water District is an equal opportunity employer and encourages application from all persons regardless of race, creed, color, sex, national origin, marital status, age, physical, mental or sensory disability unless based upon a bona fide occupation qualification (RCW 49.60 and WAC 1162-12-170).
21. Are you 18 years or older?

    1. Yes
    2. No
23. Are you a U.S. Citizen or are you authorized to work in the U.S.?

    1. Yes
    2. No
25. Can you perform the essential functions of the job, with or without reasonable accommodation?

    1. Yes
    2. No
27. Do you have any activities, commitments, or responsibilities that may prevent you from meeting work attendance requirements? If yes, explain.
29. Do you have any relatives employed by Woodinville Water District? If yes, explain.
31. Comments
35. Training & Schooling
37. High School
38. Did you graduate?

    1. Yes
    2. No
40. Location
    City and State
41. If you didn't graduate, do you have a GED?

    1. Yes
    2. No
43. College or University
44. Did you graduate?

    1. Yes
    2. No
46. Location
    City and State
47. Credit Hours
48. Major
49. Degree
51. Other Training
    Describe
52. Location
54. Training Institution
55. Credit Hours
56. Certificate Earned
60. Regular Driver's License
62. License/Certificate
63. Issuing Agency
64. Expiration Date
    Expiration Date
65. Status
67. Commercial Driver's License: Indicate Type (A, B, C)
69. License/Certificate
70. Issuing Agency
71. Expiration Date
    Expiration Date
72. Status
74. Other (Indicate type):
76. License/Certificate
77. Issuing Agency
78. Expiration Date
    Expiration Date
79. Status
83. References
85. 1.
87. Name
88. Position
89. Relationship
91. Phone
92. Email
94. 2.
96. Name
97. Position
98. Relationship
100. Phone
101. Email
103. 3.
105. Name
106. Position
107. Relationship
109. Phone
110. Email
112. 4.
114. Name
115. Position
116. Relationship
118. Phone
119. Email
121. 5.
123. Name
124. Position
125. Relationship
127. Phone
128. Email
132. Previous Employment Instructions
     Previous Employment Instructions: Complete this section in detail. A resume will not substitute for a completed application form. Beginning with your present or most recent employment, list your work experience history. Limit your history to the last 10 years unless you feel that work experience is related to this position. Include any periods of self-employment, unemployment, U.S. military service, and any job-related volunteer experience. If additional space is necessary, attach a separate sheet.
134. 1.
136. Job Title
138. Supervisor’s Name
139. Supervisor’s Phone
140. May we contact them?

     1. Yes
     2. No
142. Employer’s Name
143. Employer’s Phone
145. Address
147. City
148. State
149. Zip Code
151. Hours Per Week
152. Dates Employed
     Dates Employed Start Date

     —

     Dates Employed End Date
154. Number of Employees Supervised by You
156. Duties
158. Reason for Leaving
160. 2.
162. Job Title
164. Supervisor’s Name
165. Supervisor’s Phone
166. May we contact them?

     1. Yes
     2. No
168. Employer’s Name
169. Employer’s Phone
171. Address
173. City
174. State
175. Zip Code
177. Hours Per Week
178. Dates Employed
     Dates Employed Start Date

     —

     Dates Employed End Date
180. Number of Employees Supervised by You
182. Duties
184. Reason for Leaving
186. 3.
188. Job Title
190. Supervisor’s Name
191. Supervisor’s Phone
192. May we contact them?

     1. Yes
     2. No
194. Employer’s Name
195. Employer’s Phone
197. Address
199. City
200. State
201. Zip Code
203. Hours Per Week
204. Dates Employed
     Dates Employed Start Date

     —

     Dates Employed End Date
206. Number of Employees Supervised by You
208. Duties
210. Reason for Leaving
212. 4.
214. Job Title
216. Supervisor’s Name
217. Supervisor’s Phone
218. May we contact them?

     1. Yes
     2. No
220. Employer’s Name
221. Employer’s Phone
223. Address
225. City
226. State
227. Zip Code
229. Hours Per Week
230. Dates Employed
     Dates Employed Start Date

     —

     Dates Employed End Date
232. Number of Employees Supervised by You
234. Duties
236. Reason for Leaving
238. 5.
240. Job Title
242. Supervisor’s Name
243. Supervisor’s Phone
244. May we contact them?

     1. Yes
     2. No
246. Employer’s Name
247. Employer’s Phone
249. Address
251. City
252. State
253. Zip Code
255. Hours Per Week
256. Dates Employed
     Dates Employed Start Date

     —

     Dates Employed End Date
258. Number of Employees Supervised by You
260. Duties
262. Reason for Leaving
266. To assure the District hires the best person possible, the District considers the information furnished on this application to be only one-step in the hiring process. For this reason, it is the District’s policy to supplement and verify your information.
268. I authorize the District to investigate all statements in this application and to secure any necessary information from all my employers, references, and academic institutions. I hereby release all of those employers, references, and academic institutions, and the District from any and all liability arising from their giving or receiving information about my employment history, my academic credentials or qualifications, and my suitability for employment with the District.
270. I also authorize the District to make any investigations and inquiries of my driving history that may be necessary to arrive at a decision regarding my possible employment by the District. This includes obtaining an Abstract Driving Record.
272. I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my academic credentials, and employment references. I further understand that any false or misleading statement will be sufficient cause for rejection of my application if the District has not employed me and for immediate dismissal if the District has employed me. I also authorize the District to supply information about my employment record, in whole or in part, in confidence to any prospective employer, government agency, or other party having a legal or proper interest, and I hereby release the District from any and all liability for its providing this information. I hereby acknowledge that I have read and understand the preceding statement.
274. Signature
275. Date
     Date
277. In accordance with the Immigration and Nationality Act (INA), Section 274A, all new employees must show employment authorization and identity. This will be done by proof of a Driver’s License, a Social Security Card, a U.S. Birth Certificate, or other documentation designated by the Attorney General, or documents which will establish both an individual’s employment authorization and identity are (1) a U.S. Passport, (2) a Certificate of U.S. Citizenship or Naturalization, (3) U.S. Citizen Identification Card (INS issued), (4) an Un-Expired Foreign Passport properly endorsed to show work authorization, (5) a Resident Alien Registration Receipt Card or, (6) an Un-Expired INS Work Permit. These verification requirements apply to any person or employer hiring or recruiting any individual for work. This must be done within 24 hours after being hired.
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279. 1. Receive an email copy of this form.
280. Email address

     This field is not part of the form submission.

281. Submit

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