Job Application Please use the form below to apply for all positions. Position Applied For* Check each type of work you will accept:* Regular Temporary Full Time Full Time Part Time Evening Night Weekend Can you perform any or all job functions of the position for which you are applying, either with or without reasonable accommodations?* Yes No Personal InformationName* First Middle Initial Last Current Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long at Current Address?* Previous Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How Long at Previous Address? Home Phone*Work PhoneCell Phone*Email* General InformationSocial Security No.* Driver's License No.* Class* State* Are you related to any employee of the Authority?*An employed relative does not exclude applicant from consideration for employment. However, relationship to an employee may be considered for business reasons of supervision, safety, security or morale and affects the availability of a position in a particular department, division or shift. Every Employee appointed to a position at Silicon Valley Clean Water shall serve at the will and pleasure of the appointing agency. Yes No Name of person you are related to* First Last Relationship* EducationCollege / UniversityIf you have more than one to enter, click the + icon to the right of the fields to create a second row of fields.NameLocation# of YearsGraduated? (Y/N)Diploma / DegreeMajor SubjectsTotal Semester Units CompletedTotal Quarter Units Completed High School Name High School Location Did you graduate? Yes No If NO, do you have a GED, California High School Proficiency Certificate or equivalent? Yes No Other SchoolsIf you have more than one to enter, click the + icon to the right of the fields to create a second row of fields.NameLocation# of YearsGraduated? (Y/N)Diploma / DegreeMajor SubjectsTotal Semester Units CompletedTotal Quarter Units Completed Describe fully any job-related skills, knowledge, special training, certification or licenses you may possess. Attach additional sheets as necessary.Employment HistoryList below all employment over the last 10 YEARS starting with your most recent employer. If you were not employed for compensation during that period, please include all unpaid employment or volunteer work experience. Please include all information requested. RESUMES MAY BE ATTACHED FOR ADDITIONAL INFORMATION, BUT WILL NOT BE ACCEPTED IN LIEU OF A COMPLETED AUTHORITY APPLICATIONUpload Files (optional)Acceptable formats are: jpg, jpeg, gif, png, pdf. Maximum total file size 100MB. Drop files here or Select files Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 50 MB. How many employment records do you have to share?*If you have more than 5, please use the File Upload to submit more information. 1 2 3 4 5 Employment 1 (Most Recent)From (Mo/Yr)To (Mo/Yr)Employer NameEmployer AddressEmployment 1 (Most Recent)Position/ TitleSupervisor/ TitlePhoneReason for LeavingMay we contact employer? (Y/N)Description of Duties (1)Employment 2From (Mo/Yr)To (Mo/Yr)Employer NameEmployer AddressEmployment 2Position/ TitleSupervisor/ TitlePhoneReason for LeavingMay we contact employer? (Y/N)Description of Duties (2)Employment 3From (Mo/Yr)To (Mo/Yr)Employer NameEmployer AddressEmployment 3Position/ TitleSupervisor/ TitlePhoneReason for LeavingMay we contact employer? (Y/N)Description of Duties (3)Employment 4From (Mo/Yr)To (Mo/Yr)Employer NameEmployer AddressEmployment 4Position/ TitleSupervisor/ TitlePhoneReason for LeavingMay we contact employer? (Y/N)Description of Duties (4)Employment 5From (Mo/Yr)To (Mo/Yr)Employer NameEmployer AddressEmployment 5Position/ TitleSupervisor/ TitlePhoneReason for LeavingMay we contact employer? (Y/N)Description of Duties (5)Please explain fully any gaps in your employment history.Have you ever been dismissed or asked to resign from any job?* Yes No Please explain the circumstancesPlease read, confirm below and sign*I understand and acknowledge that: 1. If I am offered employment, I will, as a condition of employment, be required to submit proof of my identity, as well as verification that I have the legal right to work in the United States. 2. If I am employed, any false statement, misrepresentation, or omission of material facts on this application, on any supporting documents, or provided orally, regardless of when discovered to be false, may result in my immediate dismissal. 3. If I am offered a position, it will be offered on condition that my employment shall be at will without any right to continuing employment and for no definite period, and that my employment may be terminated at any time, with or without cause, and with or without prior notice. 4. Silicon Valley Clean Water may require me to submit to a test for the presence of illegal drugs in my system prior to employment and at any time during my employment, to the extent permitted by law. I also understand that any offer of employment may be made contingent upon my passing a job-related physical examination test, performed by a doctor selected by Silicon Valley Clean Water. I consent to the disclosure of the result of this physical examination and related tests to Silicon Valley Clean Water. 5. In exchange for Silicon Valley Clean Water’s consideration of my application for employment, I authorize investigation of all statements contained in this application and any supporting documents. I authorize the Silicon Valley Clean Water to obtain employment related information about my experience and qualifications from former employers, educational institutions, government agencies, or any references that I have provided. I hereby authorize those parties to provide such information concerning the subjects covered herein, and I hereby release Silicon Valley Clean Water and all parties providing information in response to such investigation from any liability arising from the investigation. 6. In exchange for Silicon Valley Clean Water’s consideration of my application for employment, I hereby authorize my former employers to release to Silicon Valley Clean Water any personnel information and records, favorable or otherwise, which my former employer has kept regarding my employment, including my work performance. I understand that Silicon Valley Clean Water may retain photocopies of my records for its files, whether I am offered employment or not. I hereby release all parties, including my former employers and Silicon Valley Clean Water, from any liability arising from the release, review and retention of my records. 7. Alterations or amendments to the above conditions may only be made in writing, signed by the Manager of Silicon Valley Clean Water. I have read, understand, and agree to all of the above statements and agreements.My signature below indicates that I have read, understand, and agree to all of the above statements and agreements.*Name of Signatory* First Last Would you like a copy of your submitted application emailed to you?* Yes No Email Address to send submitted application* PhoneThis field is for validation purposes and should be left unchanged.