"*" indicates required fields Please type or print clearly in black ink. Fill out the entire application completely and accurately. If questions are not applicable, enter “NA.” Do not leave questions blank. Be sure to sign the application when completed. South Valley Sewer District is a local district created under the laws of the State of Utah. This application becomes a public record and may be subject to disclosure under applicable provisions of the Government Records Act. South Valley Sewer District is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services. If you need any reasonable accommodations to participate in the application process (such as, assistance in completing the application, accommodations for the interview, accommodations for any job-related employment tests, or any other needed accommodation), please contact the General Manager.Employee InformationName* First Middle Last Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* List any other names used if different from the name on this application: Position InformationPosition Applying For:* Date Available to Start: MM slash DD slash YYYY Type of Employment Acceptable:* Full-Time Part-Time Temporary/Seasonal Eligibility InformationAre you at least 18 years of age?* Yes No Do you have a legal right to work in the United States?* Yes No Are you related to anyone who works for or holds an elected position with South Valley Sewer District?* Yes No If yes, name of relative and relationship to you:* Have you ever been employed by South Valley Sewer District?* Yes No If necessary for the job, are you able to provide a valid Driver’s License?* Yes No If necessary for the job, do you have a valid Commercial Driver’s License?* Yes No Education HistoryApplicants may be required to provide proof of diploma, degree, transcripts, licenses, certifications, etc.High School Name and Location of School Years Completed Major or Course of Study Degree Obtained College/University Name and Location of School Years Completed Major or Course of Study Degree Obtained Graduate School Name and Location of School Years Completed Major or Course of Study Degree Obtained Technical School Name and Location of School Years Completed Major or Course of Study Degree Obtained Skills and QualificationsOther qualifications, such as special skills, abilities or honors applicable to the position:*Other professional licenses, certifications or registrations applicable to the position:*ReferencesList two (2) personal/professional references who are not relatives. References provided in this section may be contacted.List two (2) personal/professional references who are not relatives. References provided in this section may be contacted.* Name Address Telephone List two (2) personal/professional references who are not relatives. References provided in this section may be contacted.* Name Address Telephone Employment HistoryList your work experience for the past ten (10) years beginning with your most recent job and work back. Information provided in this section may be verified with former or current employers. For all employment positions other than temporary/seasonal, a resume is required (in addition to filling out the following information). Attach resume.Employer:* Start Date:* MM slash DD slash YYYY Position Held:* Current Salary:* Employer Address:*Leaving Date:* MM slash DD slash YYYY Immediate Supervisor:* List duties you performed, skills you used or learned, positions held and promotions:*Specific Reason for Leaving:*Employer: Start Date: MM slash DD slash YYYY Position Held: Current Salary: Employer Address:Leaving Date: MM slash DD slash YYYY Immediate Supervisor: List duties you performed, skills you used or learned, positions held and promotions:Specific Reason for Leaving:Employer: Start Date: MM slash DD slash YYYY Position Held: Current Salary: Employer Address:Leaving Date: MM slash DD slash YYYY Immediate Supervisor: List duties you performed, skills you used or learned, positions held and promotions:Specific Reason for Leaving:Applicant CertificationPlease read the following statements carefully and indicate your understanding and acceptance by signing in the space provided: I hereby certify that I have personally completed this application, or have noted the name of the individual assisting me in the completion of this application. I certify that all of the information provided by me in connection with this application is true and correct to the best of my knowledge. I understand that any misstatement, falsification or omission of information or material fact on this application or any document used to secure employment may be grounds for rejection of this application, refusal to hire, or immediate termination if hired, regardless of the time elapsed before discovery. I hereby authorize South Valley Sewer District to thoroughly investigate my references, work record, education, and other matters related to my suitability and qualifications for employment with the District. I authorize South Valley Sewer District to contact any of my former employers and/or the persons or organizations referenced in this application concerning my previous employment, education, service, or any other information they might have with regard to the subjects covered by this application. I further authorize my former employers and/or persons or organizations referenced in this application to disclose to South Valley Sewer District any and all letters, reports or other information concerning my previous employment, education, service, or any other information they might have with regard to the subjects covered by this application. I hereby release South Valley Sewer District, my former employers, and other persons or organizations from any and all claims, demands, and liabilities arising or which may result from furnishing such information to South Valley Sewer District. I understand that South Valley Sewer District is subject to and shall comply with the Immigration Reform and Control Act of 1986, as amended. I understand as a condition of employment that I will be required to provide legal proof of authorization to work in the United States. I understand that South Valley Sewer District participates in the federal Employment Eligibility Verification Program (E-Verify), and that if hired, my continued employment will be contingent upon confirmation of my employment eligibility through the E-Verify system. I understand that this is a preliminary application for employment and that no contract for employment is created hereby. I further understand that, if hired, I may be required to work overtime hours and/or hours outside a normally defined work day or work week, subject to overtime compensation to the extent required by law for nonexempt positions. I understand that South Valley Sewer District has a drug and alcohol policy and that I will be subject to pre-employment, random, reasonable suspicion, and other authorized drug and/or alcohol testing as a condition of employment in accordance with District policies. I hereby authorize South Valley Sewer District to conduct a pre-employment drug screen if I am presented with a job offer. I also agree to allow the District to determine my competence and qualification for certain positions by obtaining credit, criminal, drivers license, and other job-related information about me. I understand that if such checks are involved, I may be informed of their contents by submitting a written request, and that I have a right to respond to any findings which I believe to be incorrect.Signature of Applicant*Date* MM slash DD slash YYYY If this application has been completed by an individual other than the above applicant, please print name here: How did you hear about us? Δ