Distribution Supervisor Application Personal Information Please complete the following application for the Distribution Supervisor position. First Name (required) Middle Initial Last Name (required) Street Address (required) City (required) State (required) Zip (required) Phone Number (required) Email Address (required) Are you at least 18 years of age? (required) Yes No Do you currently live with in 30 minutes of Clifton, CO? (required) Yes No If "NO" are you planning on relocating to the area and if so when? If you are related to any of our employees, please state the name of the employee and the employee's position, if known. Are you lawfully authorized to work in the United States? (required) Yes No Desired Wage Work Availability When will you be available for work? (required) Do you have any commitments that will require you to be absent from work during regular work hours for more than three consecutive days within the next six months? (required) Yes No If "YES" please explain Are you able to work nights, weekends, and holidays when necessary? (required) Yes No Employment History List chronologically every employer during the past 10 years beginning with most current. Upload additional sheets, if necessary. Do Not Omit any prior employment within this period. Current or Most Recent Employer Company Name (required) Company Address (City and State) (required) Phone # (required) Start Date (Mo/Yr) to End Date (Mo/Yr) (required) Position (required) Duties (required) Reason for Leaving (required) Can we talk to your current employer now, or only if you are hired? (required) Yes Only if Hired Employer #2 Company Name Company Address (City and State) Start Date (Mo/Yr) to End Date (Mo/Yr) Position Duties Reason for Leaving Can we contact this employer? Yes No Employer #3 Company Name Company Address (City and State) Start Date (Mo/Yr) to End Date (Mo/Yr) Position Duties Reason for Leaving Employer #4 Company Name Company Address (City and State) Start Date (Mo/Yr) to End Date (Mo/Yr) Position Duties Reason for Leaving Employer #5 Company Name Company Address (City and State) Start Date (Mo/Yr) to End Date (Mo/Yr) Position Duties Reason for Leaving Upload any additional documents. Upload Cover Letter Upload Resume Upload Additional Employment Information Additional Employment Information Have you ever been employed by us before? (required) Yes No If "YES" please state the positions held, period of employment and reason for leaving. Explain any gaps in your work history that are longer than six months. Have you ever been fired from a job or quit under threat of being fired? (required) Yes No If "YES" when and who was the employer? What reason did the employer give you for your dismissal or forced resignation? Please describe any problems in your current job about which you have been warned or disciplined during the past 12 months: Job Requirements Do you currently have a Water Distribution System Operator Level 1, 2, 3, or 4 Certification? (required) Yes No If "YES" what Level of Certification do you have? 1 2 3 4 Do you have a valid commercial driver's license? (required) Yes No Do you meet the educational and experience qualifications of the position? (required) Yes No If "NO" what qualifications do you lack? I have reviewed the essential job functions and state that I can perform these functions with or without reasonable accommodation. (required) Yes No Education Information High School Name: (required) High School Diploma or GED (required) Yes No College Name: Degree Yes No Major/Minor If "YES" what type of degree? Technical or Graduate School Name: Major Subjects Graduated? Yes No Do you have any special training or skills that you believe are relevant to this position? Illegal Drugs Within the past 60 days, have you used marijuana, cocaine, any narcotics, amphetamines, barbiturates, or other controlled substances that were not taken as prescribed to you by a physician? Yes No Professional References (no relatives): Please identify 3 professional (work) references. Professional Reference #1 Name (First and Last) Email Address Phone Number Relationship and Years Acquainted Reference #2 Name (First and Last) Email Address Phone Number Relationship and Years Acquainted: Reference #3 Name (First and Last) Email Address Phone Number Relationship and Years Acquainted: How did you hear about this opening? (required) Indeed Facebook LinkedIn Clifton Water District Website Handshake Connecting Colorado Current Employee Customer/Friend Other PLEASE READ THE FOLLOWING PARAGRAPH BEFORE SIGNING THIS APPLICATION I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation of information by statement or omission will result in disqualification or, if already hired, dismissal from employment, no matter when the misrepresentation is discovered. I authorize Employer to contact my references, investigate my employment history, education, criminal record, and if applicable, driving record, and to obtain a consumer report regarding me. I agree to assist Employer in obtaining background information on me by signing any authorization/release forms necessary to obtain such information. I will submit to and pass any drug test required by Employer as a condition of employment. All employment with Employer is at-will, meaning that employment with Employer may be terminated, with or without cause, and with or without prior notice, at any time, at the option of either me or the Employer. I understand that no supervisor or manager has the authority to enter into an agreement for employment that waives Employer’s right to terminate employment at will. I understand that Employer has policies and procedures that I must follow, if hired. I understand that Employer reserves the right to change its policies and procedures, including personnel policies and employee benefits at any time without approval by employees, and that these changes are accepted by continuing my employment with Employer. I certify that I am submitting this application because of a good faith desire for employment with Employer. If offered employment, I will consider the offer, and if I accept, I will fulfill the requirements of the job to the best of my ability. Your Signature (required) Confirm e-Signature Review Electronic Records and Signatures Policy (required)Read our Electronic Record and Signature Disclosure I agree to use electronic records and signatures There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
