Application

1Personal Information

2Position Desired

3Background Information

4Employment History

5References

6Application Preview and Submission

Which position are you applying for today?*

How did you hear about this positon?*

Google Search

Indeed

Monster

Newspaper

Friend

Relative

Beckley Sanitary Board Employee

Other

Please Specify which Employee:*

First Last

Please Specify:*

Personal Information

Name*

First Middle Last

Last Four Digits of Social Security No.*

Address*

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

Email Address*

Home Phone*

Alternate Phone*

Are employment records pertaining to you kept under any other name?*

Yes

Are you at least 18 years of age?*

Employment is subject to verification of minimum legal age.

Yes

Give The Full Name:*

First Middle Last

Are you able to produce proof of identity & eligbility for employment in the United States?*

Ex. Driver's License, Social Security Card, Birth Certificate, Immigration Documentation.

Yes

You will be asked to undergo a pre-Employment Drug Test. Are you willing to undergo a Drug Test?*

Yes

A prerequisite to employment with Beckley Sanitary Board is the completion of a criminal background check. Are you willing to authorize a pre-employment background check?*

Yes

Have you been convicted of a misdemeanor or felony?*

Yes

Please Explain:*

In case of Emergency Notify:*

First Last

Their Phone Number:*

Availability

Position Applied for:*

(Be Specific)

DATE AVAILABLE*

MM slash DD slash YYYY

Full/Part Time*

Full Time

Part Time

Are you willing to work weekends?*

Yes

Are you willing to work emergency "Call Outs"?*

Yes

Do you have any commitments to another employer which might affect your employment with us?*

Yes

Please explain:*

Salary Expected:

Annually*

Hourly*

Skills

List any special educational training, including: vocational, workshops, training, etc. that may be applicable to the position you are seeking:*

Additional Skills (office-computer) or equipment you can operate:*

License or Certification

List

Click on the "+" icon to add additional Licenses or Certifications.

Type

State

Date Received

Last Renewal

Certificate Number

List membership in professional organizations and offices held, if any:

Education

Are you attending school now?*

Yes

Course of Study*

Select last year of school completed:*

Select last year of college completed:*

Select last year of Business or Trade School completed:*

High School

Name*

City/State*

Graduated?*

Yes

Major Area of Study*

Degree*

College

Name*

City/State*

Graduated?*

Yes

Major Area of Study*

Degree*

Business or Trade School

Name*

City/State*

Graduated?*

Yes

Major Area of Study*

Degree*

Military Service

Branch:

Rank at Discharge:

Type of Discharge:

Briefly Describe your Duties:

Employment History

Please list the names of present and previous employers in order, beginning with the most recent employer. Include periods of military service, self-employment, and unemployment.

Please Upload a Copy of Your Resume*

Accepted file types: pdf, Max. file size: 256 MB.

Employment History

Job Title	Employer	Phone Number	May We Contact?	Actions

There are no Entries.

Maximum number of entries reached.

Have you previously worked for Beckley Sanitary Board?*

Yes

Are any of your relatives working at Beckley Sanitary Board?*

Yes

Please complete the following:

Position Title*

Supervisor*

Date to:*

MM slash DD slash YYYY

Date from:*

MM slash DD slash YYYY

Reason for Leaving:*

References

References*

Name

Company/Title

Address

Phone

Years Known

Notice

I certify that the information given by me on this application is true. I agree if the information is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. I understand that this employment application and any other Beckley Sanitary Board documents are not contracts of employment, express or implied. If hired, I may voluntarily leave employment or may be terminated by Beckley Sanitary Board at any time and for any or no reason, with or without cause. Beckley Sanitary board employees are at-will employees. I also understand that I may be offered employment conditioned on my successfully passing criminal and/or successfully passing other background checks and/or drug tests and/or physical exams to the satisfaction of Beckley Sanitary Board.

Information Release Authorization*

I authorize Beckley Sanitary Board's agents to contact by phone, correspondence, or in person, my previous employers and personal references to determine fitness for employment and may include, but is not limited to: employment history verification, job performance, disciplinary record, criminal background investigation, character, and reputation. I further acknowledge I will not pursue any legal claims, including, but not limited to, defamation, libel, slander, or invasion of privacy against Beckley Sanitary Board.

By signing this agreement, I agree to hold harmless any previous employer, or agent of that organization, or any individual providing information in this authorization. I further authorize Beckley Sanitary Board to provide a copy of this release upon request.

Signature of Applicant*

Date*

MM slash DD slash YYYY

{all_fields}

Personal Information

Availability

Salary Expected:

Skills

License or Certification

Education

High School

College

Business or Trade School

Military Service

Employment History

Please complete the following:

References

Notice

ABOUT THE BSB

CUSTOMER SERVICE

EDUCATION