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Home
Pay My Bill
Billing & Service
Methods of Payment
New Service
Rates & Fees
Rental Accounts
Utility Bill Adjustments
Water Quality
Backflow-Cross Connection
Conservation
Reports
Resources
Articles
Employees
Employment
Financials
Forms
Links
Regulations
Vendors
About
About BCPSD
Leadership
Meetings
Our Community
Contact
Customer Service
Broad Creek Public Service District
Employment Application
Applicant Information
Name
*
First Name
Last Name
Date
*
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone
*
(###)
###
####
Cell Phone
*
(###)
###
####
Email
*
Date Available
*
Social Security Number
*
Desired Salary
*
$
Position Applied for
*
Are you a citizen of the United States?
*
Yes
No
If no, are you authorizd to work in the U.S.?
*
Yes
No
Have you ever worked for this company?
*
Yes
No
If yes, when?
*
Have you ever been convicted of a felony?
*
Yes
No
If yes, explain
*
Education
High School
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
From
*
To
*
Did you graduate?
*
Yes
No
Degree
*
College
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
From
*
To
*
Did you graduate?
*
Yes
No
Degree
*
Other
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
From
*
To
*
Did you graduate?
*
Yes
No
Degree
*
References
Please list three references.
Name
*
First Name
Last Name
Relationship
*
Company
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Name
*
First Name
Last Name
Reationship
*
Company
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Name
*
First Name
Last Name
Relationship
*
Company
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Previous Employement
Company
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Supervisor
*
Job Title
*
Starting Salary
*
$
Ending Salary
*
$
Responsibilities
*
From
*
To
*
Reason for Leaving
*
May we contact your previous supervisor for a reference?
*
Yes
No
Company
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Supervisor
*
Job Title
*
Starting Salary
*
$
Ending Salary
*
$
Responsibilities
*
From
*
To
*
Reason for Leaving
*
May we contact your previous supervisor for a reference?
*
Yes
No
Company
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Supervisor
*
Job Title
*
Starting Salary
*
$
Ending Salary
*
$
Responsibilities
*
From
*
To
*
Reason for Leaving
*
May we contact your previous supervisor for a reference?
*
Yes
No
Military Service
Branch
From
To
Rank at Discharge
Type of Discharge
If other than honorable, explain
Disclaimer and Signature
Digital 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 any detrimental discoveries as a result of my authorized background check may result in my release.
Date
*
MM
DD
YYYY
Thank you for your submission.
