Texarkana Water Utilities
Employment Application

Position Applied For
Today's Date
Last Name
First Name
Middle Name
Address
City
State
Zip
Home Telephone
Other Telephone
Social Security Number

Have you ever been employed with Texarkana Water Utilities?  Yes            No
If Yes, Note Dates and reason for leaving

May we contact your present employer?  Yes            No

Within the past 10 years have you been convicted of a crime involving violence or dishonesty?  Yes            No
If Yes, Please describe

Education
(Beginning with most recent)
Yrs Attended Name & Location of School's Attended Graduated Education Level Subjects of Study
 Yes
 No
 Yes
 No
 Yes
 No

Previous Occupations
(Beginning with most recent)
Previous Occupation Number 1
From (Month & Year)
To (Month & Year)
Telephone No.
Title of Position
Name and Address of Employer


Supervisor

Reason for Leaving


Exact Nature of Responsibilities
Previous Occupation Number 2
From (Month & Year)
To (Month & Year)
Telephone No.
Title of Position
Name and Address of Employer


Supervisor

Reason for Leaving


Exact Nature of Responsibilities
Previous Occupation Number 3
From (Month & Year)
To (Month & Year)
Telephone No.
Title of Position
Name and Address of Employer


Supervisor

Reason for Leaving


Exact Nature of Responsibilities

References
(Do Not Give Names of Relatives)
Name Occupation Home Address/City/State Telephone No.

Service in the United States Armed Forces From      To

Present Service Affiliations (Reserves, National Guard, etc.)

Professional Memberships

Professional Licenses

Scholastic Honors or awards received

Civic and Service Organizations

Driver's License      Yes       No

In order to assure proper placement, please list any special skills, training, or experiences which qualify you for the position for which you are applying.


I understand that I will be required to satisfactorily complete a six - month probationary period during which time my employment may be terminated for failure to meet the minimum standards required by my employment.
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Texarkana Water Utilities in considering my application for employment, may verify the information set forth on this application and obtain additional background information relating to my background. I authorize all persons, schools, companies, corporations, credit bureaus, law enforcement agencies, and doctors to supply any information concerning my background. I have read, understand, and agree to this statement.
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I understand that Texarkana Water Utilities has a commitment to maintain an alcohol/drug free workplace and that Texarkana Water Utilities, unless prohibited by state law, requires a drug screening test as part of its selection and hiring process. I understand that such drug screening will consist of the testing of a urine sample, or other medically recognized test designed to detect traceable amounts of a controlled substance in my body. If any detectable amounts are found in my body, a second test, approved by the NIDA will be performed on the same specimen. If the results of the second test are also positive, I will be disqualified from consideration for employment and any offer of employment withdrawn. I further understand and agree that if I am employed, I may be required to submit to alcohol/drug testing under certain circumstances during my employment. I have read, understand and agree to the statement above.
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I understand that this application is good for sixty (60) days from today's date. If I still desire a position with Texarkana Water Utilities after this application expires, it will be my reponsibility to fill out a new application and file it with the company. Otherwise, Texarkana Water Utilities will not consider me for employment after this application expires.
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Texarkana Water Utilities will make reasonable accommodations to the known physical and mental limitations of otherwise qualified handicapped applicants and employees unless the accommodation would impose an undue hardship on the operation of the program. If you have a disability requiring such accommodations, please inform us at the time of an interview.

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WE ARE AN EQUAL OPPORTUNITY AFFIRMATIVE ACTION EMPLOYER