MSD General Application for Employment

How did you find out about this job posting? *

All applicants will be considered for employment without regard to race, religion, color, sex, national origin, marital or veteran status, medical condition, disability or any other status protected by law. We are an Equal Opportunity Employer.

Personal

Last Name *

First Name *

Middle Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Telephone # *

Email Address:

SS #

Note: Your Social Security number is optional. If you do not feel comfortable giving this information at this time, you will have a chance to submit it at a later date if needed.

Do you have a valid driver's license?

Yes

If you have a valid driver's license, what is the class?

If you have a valid driver's license, please list any endorsements you have on the license? (Example: Tanker Endorsement)

Position Applying For ("Any" will not be considered.) *

Salary Expected *

Are you at least 18 years of age? *

Yes

If "No", a work permit will be required.

Are you a citizen or legally eligible for employment in the United States? *

Yes

If you are not a U.S. citizen, alien registration card required.

Have you worked for us before? *

Yes

If "Yes", when?

and what position?

Are you related by blood or marriage to any MSD employees? *

Yes

If "Yes", give name, relationship and department

Are you willing to work the following

Overtime		Nights
Weekends		Holidays

General Education

High School Name *

Location *

Check highest school year completed *

If you did not graduate, do you have a GED (General Education Development) high school equivalency?

Yes

Education Beyond High School

College or University:

Name and Location

Years Completed

Degree

Major Subject

Graduate or Professional:

Name and Location

Years Completed

Degree

Major Subject

Other Education:

Name and Location

Years Completed

Degree

Major Subject

Special Skills

Do you speak, write or understand any foreign languages?

Yes

If "Yes", which language(s)?

List any experience, training, qualifications or skills which you feel make you especially suited for work at MSD. (Maximum 100 characters.)

Professional Society Memberships

Licenses (list states)

Computer Skills

List any hardware skills, date last used and your level of proficiency. (Maximum 100 characters.)

List any software skills, date last used and your level of proficiency. (Maximum 100 characters.)

Additional Information

Use the following space to summarize other relevant experience, skills and background. (Maximum 100 characters.)

Employment History

List all previous employers starting with your present or most recent position (last 10 years is sufficient) below.

Name of Company

Name of Supervisor

Address

Telephone #

Position and Duties

Dates of Employment

Starting Rate of Pay

Ending Rate of Pay

Reason for Leaving

Name of Company

Name of Supervisor

Address

Telephone #

Position and Duties

Dates of Employment

Starting Rate of Pay

Ending Rate of Pay

Reason for Leaving

Name of Company

Name of Supervisor

Address

Telephone #

Position and Duties

Dates of Employment

Starting Rate of Pay

Ending Rate of Pay

Reason for Leaving

Military Service

If you have any military service, please list below.

Branch of Service

Dates of Service

Rank

Specialization & Duties

Honorably Discharged?

Yes

If "No", please explain.

References

List three persons living in the United States 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 NAMES OF SUPERVISORS.

Name

Address

Telephone #

Name

Address

Telephone #

Name

Address

Telephone #

Resume

If the position you are seeking requires a resume, please send a copy of your resume to mtroughton@msdbc.org. You may also upload your resume here.

Upload your resume. Acceptable formats are .pdf, .doc, .docx, and .txt. File size limit is 10 megabytes.

Pre-Employment Authorization (Read Carefully)

I certify to the best of my knowledge and belief, the information given truly represents my background and experience. I understand that if I have knowingly misrepresented or falsified any of the application information I may be disqualified for employment consideration or dismissed from employment with the Metropolitan Sewerage District of Buncombe County. I authorize my former employer to give any information regarding my employment. I have authorized them to release my records and discuss my work performance with representatives of the Metropolitan Sewerage District who will investigate the responses provided herein. I understand that proof of my eligibility of employment in the United States must be furnished before I begin work with the Metropolitan Sewerage District. I understand that North Carolina State law requires male applicants for employment, 18 to 26, to register for military service. By signing below I certify that I am in compliance with state law. I understand that my social security number will be kept confidential and used only in accordance with federal, state and local laws. I understand that a pre-employment drug screening is required.

Signature (Type Full Name) *

Date *

Metropolitan Sewerage District of Buncombe County, North Carolina 2028 Riverside Drive Asheville, North Carolina 28804 (828) 254-9646 (main line) (828) 254-3299 (fax)

* = Input is required