ONONDAGA COUNTY WATER AUTHORITY
PO BOX 4949
SYRACUSE, NEW YORK 13221-4949
APPLICATION FOR EMPLOYMENT
We consider all applicants without regard to race, color, disability, sex, sexual orientation, age, religion,
national origin, marital status, citizenship, or any other legally protected status.
PLEASE PRINT OR TYPE
Position Applied For
Date of Application
Last Name
First Name
Middle
Street Address
City, State, Zip
Home Phone
Cell Phone
E-Mail Address
Social Security Number
Upon Hire
Are you currently employed?
Are you legally eligible for employment in the United States?
Did you serve in the military?
Yes
No
Yes
Yes
No
No
If Yes, what branch
On what date would you be available for work:
Are you applying to work:
Full Time
Part Time
Have you been convicted of a felony within the last 7 years?
Yes
No
If yes, explain
Do you currently hold a Commercial Driver’s License?
Describe any special training, skills or experience you have:
Yes
No
CDL -A or
CDL –B
EMPLOYMENT HISTORY
Please start with your current (or last) job and complete all information requested
Company Name
Telephone
___________________________________________________________ _____________________________
Address
Employed from ____/____/_______
___________________________________________________________ to______/____/_______
Supervisor
Weekly pay
___________________________________________________________ Starting_________Final__________
Job Title & Work Performed
Reason for Leaving
Company Name
Telephone
___________________________________________________________ _____________________________
Address
Employed from ____/____/_______
___________________________________________________________ to______/____/_______
Supervisor
Weekly pay
___________________________________________________________ Starting_________Final__________
Job Title & Work Performed
Reason for Leaving
Company Name
Telephone
___________________________________________________________ _____________________________
Address
Employed from ____/____/_______
___________________________________________________________ to______/____/_______
Supervisor
Weekly pay
___________________________________________________________ Starting_________Final__________
Job Title & Work Performed
Reason for Leaving
_
EMPLOYMENT HISTORY (Continued)
Company Name
Telephone
___________________________________________________________ _____________________________
Address
Employed from ____/____/_______
___________________________________________________________ to______/____/_______
Supervisor
Weekly pay
___________________________________________________________ Starting_________Final__________
Job Title & Work Performed
Reason for Leaving
Describe any on the job education and training received
List Professional, business, civic or volunteer activities including offices held (do not include any affiliation that would
disclose your race, color, religion or national origin
EDUCATION
School
Graduate
College
Business/Trade/Technical
High School
Names & Location of School
Course of Study
Number Years
Completed
Degree
SI GNATURE
I certify that the information provided in this Application for Employment and related papers is true,
accurate and complete. I understand that any falsification or willful omission can be grounds for
dismissal or refusal to hire.
I hereby authorize any person, educational institution, or company I have listed as a reference on my
employment application or on related papers, to disclose in good faith any information they may have
regarding my qualifications, fitness for employment and any other reasonable and necessary information
incident to the employment process. I release the Onondaga County Water Authority, any former
employers, educational institutions and any other persons giving references, from all liability for damage
that may result from use of such information.
I am aware that (1) the Onondaga County Water Authority has a drug and alcohol policy that provides for
pre-employment testing as well as testing after employment, (2) consent to and compliance with such
policy is a condition of my employment; and (3) continued employment is based on the successful
passing of testing under such policy. I further understand that continued employment may be based on
the successful passing of job-related physical examinations.
I acknowledge that this application does not create an expressed or implied employment contract.
Signature
Please Print Name
Date