CACHUMA OPERATION & MAINTENANCE BOARD
3301 Laurel Canyon Road
Santa Barbara, CA 93105-2017
Telephone (805) 687-4011
EMPLOYMENT APPLICATION
An Equal Opportunity Employer
WATER SERVICE WORKER I
Thank you for considering employment with the Cachuma Operation and Maintenance Board. To make the application process as easy as possible, please read and follow these instructions.
Name: / Date:INSTRUCTIONS:
1. Please answer all questions and provide enough detail to allow for full review and evaluation.
2. Please type or print in ink.
3. DO NOT FAX APPLICATION. Email application and resume to Janet Gingras, Administrative Manager at . If mailing, mark envelope “Confidential”.
4. Resumes will not be accepted in lieu of a completed application
5. Use a separate application for each job title. Applications and attachments will not be returned.
6. Background investigations will be conducted for position finalist. Please read the Applicant Investigation Policy carefully.
7. Please notify the Administrative Manager if you change your address or phone number during the hiring process.
Applicant Investigation Policy
Cachuma Operation & Maintenance Board (COMB) recognizes the importance of maintaining a safe workplace with employees who are honest, trustworthy, qualified, reliable and non-violent, and who do not present a risk of harm to their co-employees or others. For purposes of furthering these concerns and interests, all job applicants will be asked to sign an agreement authorizing COMB or its designated Consumer Reporting Agency to conduct and prepare an Investigative Consumer Report in compliance with federal and state laws. COMB reserves the right to exclude any applicant form consideration for employment if the applicant refuses to sign this agreement as requested.
COMB’s policies regarding terms and conditions of employment and its employee benefits are contained in the COMB Employee Handbook and related documents. After receiving an offer of employment, you must review and sign the Handbook and related documents and return signed copies to the Administrative Manager before beginning employment.
Cachuma Operation & Maintenance Board
APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer
PERSONAL INFORMATION: / DATE:Name:
Last First Middle
Other Names Used (to verify employment/educational history):Present Address:
Street City State Zip
If not at current address for more than seven (7) years, please provide prior addresses for that time period:
Prior Address:Street City State Zip
Prior Address:Street City State Zip
Telephone # Day: / ( ) - / Message Telephone #: / ( ) -Telephone # Evening: / ( ) - / Fax #: / ( ) -
Are you over age 18? / { } Yes / { } No
EMPLOYMENT DESIRED:
Position: / Date Available:{ } Full Time / { } Part Time / Specify Hours/Dates:
Are you available to work overtime as needed? / If Yes: / Weekdays? / Weekends?
If the position for which you are applying requires driving of any vehicle, provide the following:
License No.: / Issuing State: / Type: / Expiration Date:Please note: You must be licensed, and insurable in order to hold any position that requires driving. If a job offer is made you will be required to provide or authorize COMB to obtain a copy of your DMV record
EDUCATION: / Name and Location of School / Major or Course of Study / Number of Years Completed / Certificate or Degree EarnedHigh School:
Trade/Business
Correspondence School(s):
College(s):
Graduate School:
SKILLS: List the skills and licenses (including numbers) you possess that are relevant to the position you seek. Use additional paper if needed.
Do you have any other skills that you believe would benefit COMB? Please list.
FORMER EMPLOYERS: List employers below, most recent first and provide enough information to allow for review and evaluation of your work experience and abilities. If you were employed under another name, write in the name by which you were known to your employer. If additional space is needed, attach a separate sheet of paper. This section must be fully complete.
Do you authorize COMB to contact your current employer? / Yes / NoDates of Employment / Employer / Address / City / State / Zip
Hours Per Week / Title of Your Position / Supervisor’s Name & Phone No.
Salary / Type of Work Performed (be specific)
Reason for Leaving:
Dates of Employment / Employer / Address / City / State / Zip
Hours Per Week / Title of Your Position / Supervisor’s Name & Phone No.
Salary / Type of Work Performed (be specific)
Reason for Leaving:
Dates of Employment / Employer / Address / City / State / Zip
Hours Per Week / Title of Your Position / Supervisor’s Name & Phone No.
Salary / Type of Work Performed (be specific)
Reason for Leaving:
Dates of Employment / Employer / Address / City / State / Zip
Hours Per Week / Title of Your Position / Supervisor’s Name & Phone No.
Salary / Type of Work Performed (be specific)
Reason for Leaving:
Dates of Employment / Employer / Address / City / State / Zip
Hours Per Week / Title of Your Position / Supervisor’s Name & Phone No.
Salary / Type of Work Performed (be specific)
Reason for Leaving:
Dates of Employment / Employer / Address / City / State / Zip
Hours Per Week / Title of Your Position / Supervisor’s Name & Phone No.
Salary / Type of Work Performed (be specific)
Reason for Leaving:
Dates of Employment / Employer / Address / City / State / Zip
Hours Per Week / Title of Your Position / Supervisor’s Name & Phone No.
Salary / Type of Work Performed (be specific)
Reason for Leaving:
If this job requires a specific license or certificate, please complete:
Certificate of Training/Professional Registration / License No./Registration No. / Date Issued / Date Expires
GENERAL: / Have you ever been convicted of a felony or a misdemeanor?
(Do Not include any conviction under California Health & Safety Code Secitons 11357(a) or (b), 11360 (c), 11364, 11365 or 11550 related to marijuana dated more than two years ago, or any post-trial diversion program or any legally expunged conviction.
Are you currently awaiting trial for any criminal offense? / YES / NO
Have you ever been disciplined or discharged by a former employer for an act of workplace violence? / YES / NO
A “Yes” answer will not necessarily disqualify you. Please explain any “Yes” answer above fully so that individual circumstances can be considered. Use additional paper if needed.
If employed, can you produce verification of you legal right work in the United States?(New employees are required to produce documents that verify their legal right to work in the United States and to declare under penalty of perjury that these documents are their own and genuine.)
Have you previously worked for or applied for a position with COMB either as an employee or through an employment agency?
Yes / No / If yes, please explain when and, if employed, the position held:
Are you related to anyone who works for COMB or its Board of Directors by blood, marriage, adoption, or domestic partnership?
If yes, Name: / Relationship:What prompted you to apply here?
If you were referred, please state by whom:
REFERENCES: / (Give the names of three persons whom you have known for at least three (3) years
and who have personal knowledge of your work skills and history. Do not include any relative unless the relative was your employer or manager and is so identified.)
Name and Address / Business / How Long Acquainted?
I, the undersigned, authorize the above-named references to respond to COMB, or its designated Consumer Reporting Agency, for confirmation of the information in this application, and for information about my skills, work history, reliability, honesty and any tendency to behave violently or in an unsafe, harmful or threatening manner. I hereby release the above-named references from all liability arising therefrom.
Dated: / Signed:I understand that falsification (including misrepresentation or omission of facts called for) will result in immediate removal of my application from consideration or immediate discharge if such falsification is discovered after I begin employment.
COMB is an at-will employer, unless specifically notified otherwise in writing. This is, if employed you may terminate your employment at any time, for any reason, and COMB has the same right to terminate your employment at any time for any reason. This at-will relationship cannot be modified or changed during your employment except by specific written agreement between you and COMB, signed by the General Manager.
COMB is an equal opportunity employer and selects employees on the basis of ability, experience, training, and ability to work as a member of the COMB team. COMB’s policy is to fill every position without regard to race, color, religious creed, sex, marital status, age, national origin, ancestry, physical disability, sexual orientation, medical condition, or any other protected category under federal, state or local laws. Please contact the Administrative Manager of COMB if you have any questions or complaints regarding this policy.
(Signature) (Date)