Employment Application

Please fill out the form as completely as possible.
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Step 1 of 5 – Applicant Information

Comments

This field is for validation purposes and should be left unchanged.

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

How long have you lived at the current address?*

Phone*

E-Mail Address*

Write N/A if not applicable.

Best time to Call

How did you hear about this position?*

Availability Information

Position you are applying for…*

Will you work overtime?*

Have you ever been employed here before?*

Are you legally eligible for employment in this country?*

Yes

When are you available to start working?*

Work Experience

Please list your work experience for the PAST FIVE YEARS beginning with your most recent job held. If you were self-employed, then give your name as the company name. If the area does not apply, then mark the area with N/A.

Company 1

Please fill out this application completely. If the area does not apply, then mark the area with N/A. Please list your work experience for the PAST FIVE YEARS beginning with your most recent job held.

Company 1 Name*

Write N/A if not applicable.

Company 1 Address*

Street Address City State / Province / Region ZIP / Postal Code

Write N/A if not applicable.

Company 1 Phone Number*

Write N/A if not applicable.

Name of Last Supervisor at Company 1*

Write N/A if not applicable.

Job Title at Company 1*

Write N/A if not applicable.

Date you started employment at Company 1*

Date you left employment at Company 1*

Starting & Ending Salary at Company 1*

Write N/A if not applicable.

Reason for leaving Company 1*

Write N/A if not applicable.

Company 1: List the jobs you held, the duties performed, skills used or learned, advancements or promotions while you worked at this company.*

Write N/A if not applicable.

Company 2

Please fill out if applicable or mark N/A in each box.

Company 2 Name*

Write N/A if not applicable.

Company 2 Address*

Street Address City State / Province / Region ZIP / Postal Code

Write N/A if not applicable.

Company 2 Phone Number*

Write N/A if not applicable.

Name of Last Supervisor at Company 2*

Write N/A if not applicable.

Job Title at Company 2*

Write N/A if not applicable.

Date you started employment at Company 2

Date you left employment at Company 2

Starting & Ending Salary at Company 2*

Write N/A if not applicable.

Reason for leaving Company 2*

Write N/A if not applicable.

Company 2: List the jobs you held, the duties performed, skills used or learned, advancements or promotions while you worked at this company.*

Write N/A if not applicable.

Company 3

Please fill out if applicable or mark N/A in each box.

Company 3 Name*

Write N/A if not applicable.

Company 3 Address*

Street Address City State / Province / Region ZIP / Postal Code

Write N/A if not applicable.

Company 3 Phone Number*

Write N/A if not applicable.

Name of Last Supervisor at Company 3*

Write N/A if not applicable.

Job Title at Company 3*

Write N/A if not applicable.

Date you started employment at Company 3

Date you left employment at Company 3

Starting & Ending Salary at Company 3*

Write N/A if not applicable.

Reason for leaving Company 3*

Write N/A if not applicable.

Company 3: List the jobs you held, the duties performed, skills used or learned, advancements or promotions while you worked at this company.*

Write N/A if not applicable.

Company 4

Please fill out if applicable or mark N/A in each box.

Company 4 Name*

Write N/A if not applicable.

Company 4 Address*

Street Address City State / Province / Region ZIP / Postal Code

Write N/A if not applicable.

Company 4 Phone Number*

Write N/A if not applicable.

Name of Last Supervisor at Company 4*

Write N/A if not applicable.

Job Title at Company 4*

Write N/A if not applicable.

Date you started employment at Company 4

Date you left employment at Company 4

Starting & Ending Salary at Company 4*

Write N/A if not applicable.

Reason for leaving Company 4*

Write N/A if not applicable.

Company 4: List the jobs you held, the duties performed, skills used or learned, advancements or promotions while you worked at this company.*

Write N/A if not applicable.

May we contact your present and/or previous employers?*

Yes

Did you complete this application yourself?*

Yes

If you did not complete this application yourself, then who completed it?*

Write N/A if not applicable.

The application must be completed in its entirety in order to be considered for a position with Decatur County Water

Resume Upload

Please upload your resume here if you have one you would like to include in the application.

Max. file size: 64 MB.

Application Form Acknowledgement & Terms and Conditions*

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressiy authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from allreferences (personal and professional), empioyers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, entatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president. I also understand that if I am hired. I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, genetic information, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets,.threats, insults, name-calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate,or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly NOTE: This Company complies with Indiana law prohibiting smoking in enclosed areas within places of employment. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.

I acknowledge the above terms and conditions.

Signature of applicant*

3455 North Old U.S. Highway 421

PHONE: 812.663.3119

Monday- Friday:
7 a.m. - 4 p.m.

Employment Application