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Providing Great Water for Great People
About Us
History of Cleveland County Water
Board of Commissioners
Board Meetings and Minutes
Management Team
Customer Service
Developers/Contractors
Backflow Prevention/Cross Connections
Standard Details/Forms
Education
Events & Public Notices
Finance/Purchasing
Water Quality Reports
Ways to Conserve
Utility Maintenance Technician Application
EmailMeForm
Utility Maintenance Tech Employment Application
Position Applied For
Application Date
MM
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Name
*
First
Middle
Last
Email
*
Phone
*
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Street Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
GENERAL INFORMATION
Have you ever been employed with Cleveland County Water?
Yes
No
If yes, list dates of service and department
Are you related by blood or marriage to any CCW employee or Commissioner?
Yes
No
If yes, give name, relationship, and department
Are/were you a member of the U.S. Armed Forces?
Yes
No
If yes, please provide the branch of service
Have you ever been convicted of or plead guilty to a crime?
Yes
No
If yes, please explain each conviction, nature of offense, date(s) of conviction, sentence and type(s) of rehabilitation (if any). Please include any major traffic violations.
NOTE: A conviction will not automatically bar you from employment.
EDUCATION
(Give complete education history below)
High School Name:
City/State:
Did you graduate?
Yes
No
If no, do you have a High School Equivalency (GED)?
Yes
No
Additional Education
Name
City and State
Degree/Certification Received
College or University
Graduate or Professional
Other Education
Please provide any additional skills or certifications you may have relevant to the position for which you are applying.
EMPLOYMENT HISTORY
Record your complete work history in the spaces below. Begin with your current or most recent employer first. Attach additional sheets as needed. Be sure to account for gaps in your employment history. Please complete the employment history even if a resume is attached. Related volunteer experience should also be listed.
A. CURRENT OR MOST RECENT EMPLOYMENT
Job Title
From
MM
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DD
/
YYYY
To
MM
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DD
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YYYY
Employer or Company
Phone
###
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-
####
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Supervisor name and title
FULL-TIME OR PART-TIME?
Full-Time
Part-Time
If part time, please provide the number of hours worked per week
Duties
Reason for Leaving
If currently employed, may we contact?
Yes
No
B. NEXT MOST RECENT EMPLOYER
Job Title
From:
MM
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DD
/
YYYY
To:
MM
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DD
/
YYYY
Employer or Company:
Phone
###
-
###
-
####
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Supervisor name and title:
FULL-TIME OR PART-TIME?
Full-Time
Part-Time
If part time, please provide the number of hours worked per week
Duties
Reason for Leaving
C. NEXT RECENT EMPLOYMENT
Job Title
From
MM
/
DD
/
YYYY
To
MM
/
DD
/
YYYY
Employer or Company
Phone
###
-
###
-
####
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Supervisor name and title:
FULL-TIME OR PART-TIME?
Full-Time
Part-Time
If part-time, please provide the number of hours worked per week
Duties
Reason for Leaving
REFERENCES
Please provide names and contact information for three (3) people who are not related to you and who have a definite knowledge of your ability to perform the job for which you are applying.
Do not repeat the names of supervisors included in your employment history above.
Name
First
Last
Phone
###
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-
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Email Address
Name
First
Last
Phone
###
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Email Address
Name
First
Last
Phone
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Email Address
READ CAREFULLY BEFORE SUBMITTING
I certify that all answers and statements on this application are true and complete. I understand that any falsification, omission, or misrepresentation of facts in this application, in connection with any aspect of the hiring process, will be cause for either the rejection of this application or for my discharge if I have been hired.
I understand that my employment may be contingent upon my passing a physical examination. I also understand that future examinations may be required by Cleveland County Water. I am aware that Cleveland County Water requires screening for drugs as part of its pre-employment testing and that I may be required to take future examinations for drugs and/or alcohol, in accordance with Cleveland County Water policy.
I authorize Cleveland County Water to make any inquiry or investigation deemed necessary to consider my employment application. This may include contacting former employers and criminal records check. I understand that conviction of a crime will not automatically bar my employment. I may still be eligible for employment if Cleveland County Water determines my conviction could have no bearing to the job for which I am applying.
I authorize former employers and schools to release all information Cleveland County Water requests from them concerning my academic records, job performance, attendance, personal evaluation, or other related information. I release all parties which may provide information regarding my application from liability and/or damages.
If my employment with Cleveland County Water terminates for any reason, I authorize Cleveland County Water to release all information and to answer any inquiries regarding my employment, performance, and the reasons for my termination.
I understand that if I am employed my employment will include a probationary period. During and after the probationary period my employment is “at will;” it can be terminated at any time by me or Cleveland County Water. I also understand that the terms, policies, procedures, and rules of employment are not guaranteed. They are subject to change at any time by Cleveland County Water.
Although I may be employed for a specific work schedule, I understand Cleveland County Water does not guarantee my work schedule and may alter it as necessary.
I understand this application is current for only the specified job I am applying for. I will complete a new application should I not be hired for the applied for position if future job opportunities become available that I may be interested in.
SIGNATURE
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Date
MM
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DD
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YYYY
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