Completely fill out application and sign it. It is the applicant’s responsibility to ensure that the application is on file in Human Resources on the final filing date. Resumes are not acceptable in lieu of an application. Late applications will be rejected.

Completion of the following four questions are required only if the position for which you are applying requires the possession of a valid California’s Driver’s License

Please Read Carefully A resume is not acceptable in place of completing the following. Show your present or most recent job first. Show all employment during the past 10 years (or more, if qualifying Experience). Use a separate block for each Job Title (even those with same employer). Remember your acceptance depends on the completeness and accuracy of the information that is provided on this application. Important: To receive appropriate credit for work experience, date of employment must include month, day, and year. Special Licenses, Certificate, or Registration Requirements

Please identify and explain all periods of unemployment in excess of one month during the past 10 years:

The following information is requested to assist in implementing the District’s Affirmative Action and Equal Employment Opportunity policy and state and federal requirements. Submission of this information is strictly voluntary and will NOT be retained with your application but handled separately and confidentially for statistical purposes.

Disability: A person with a disability is an individual who:(1) has a physical or mental impairment or medical condition that limits one or more life activities, such as walking, speaking, breathing, performing manual tasks, seeing, hearing, learning, caring for oneself or working; (2) has a record or history of such impairment or medical condition; or (3) is regarded as having such an impairment or medical condition.

I hereby certify that the above information is true and correct and is being submitted to Apple Valley Heights County Water District (AVHCWD) to substantiate my claim to monies paid to AVHCWD. I further certify that I have the authority and right to claim and receive payment of these monies and hereby release AVHCWD, its Board members, employees, representatives, attorneys and agents from all liability and further obligation with respect to this claim. Electronic Signature: (required)