Application For Employment

Central New York’s Water Authority
PO Box 4949
Syracuse, NY 13221-4949

The Onondaga County Water Authority (OCWA) provides equal employment opportunities (EEO) to all employees
and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, national
origin, citizenship, ancestry, age, disability, arrest record, genetic predisposition, marital status, military or veteran
status, familial status, domestic violence victim status, gender identity, or any other legally protected status.

Date*
MM slash DD slash YYYY
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone*
Email*
Are you legally eligible for employment in the United States?
- Yes
- No
Are you currently employed?
- Yes
- No
Do you possess a valid New York State Driver’s License?
- Yes
- No
Do you currently hold a Commercial Driver’s License?
- Yes
- No
Type of License
Type of Employment Desired
Position Applied For:
Able to work:
- Full Time
- Part Time
Date available for employment
MM slash DD slash YYYY
Are you available to work nights?
- Yes
- No
Are you available to work overtime (including emergency call out)?
- Yes
- No
Are you available to work Weekends?
- Yes
- No
Rotating Schedule?
- Yes
- No
Education
Name of High School or Equivalency
High School or Equivalency Address
Street Address City State / Province / Region ZIP / Postal Code
Did you graduate?
- Yes
- No
Name of College or University
College or University Address
Street Address City State / Province / Region ZIP / Postal Code
Field of Study/Major
Number of years attended
Did you graduate?
- Yes
- No
Name of Graduate School
Address of Graduate School
Street Address City State / Province / Region ZIP / Postal Code
Field of study/Major
Number of years attended
Did you graduate?
- Yes
- No
Name of Business/Trade/Technical School
Address of Business/Trade/Technical School
Street Address City State / Province / Region ZIP / Postal Code
Field of study/Major
Number of years attended
Did you graduate?
- Yes
- No
Employment History
(Begin with most recent employment)
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Hidden
Employer Name
First Last
Employer Name
Employer's Phone
Supervisor Name/Title
Employer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Your Title
Description of work and responsibilities
Reason for leaving
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Hidden
Employer Name
First Last
Employer Name
Employer's Phone
Supervisor Name/Title
Employer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Your Title
Description of work and responsibilities
Reason for leaving
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Hidden
Employer Name
First Last
Employer Name
Employer's Phone
Supervisor Name/Title
Employer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Your Title
Description of work and responsibilities
Reason for leaving
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Hidden
Employer Name
First Last
Employer Name
Employer's Phone
Supervisor Name/Title
Employer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Your Title
Description of work and responsibilities
Reason for leaving
Skills and Professional Experience
Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain.
Relevant activities
If you desire, list professional, business, civic, or volunteer activities including offices held.
Referral Source
How did you hear about the Water Authority?
Signature*

Signature
I certify that the information provided in this Application for Employment and related papers is true, accurate and complete. I understand that any falsification or willful omission can be grounds for dismissal or refusal to hire. I hereby authorize any person, educational institution, or company I have listed on my employment application or on related papers, to disclose in good faith any information they may have regarding my qualifications, fitness for employment and any other reasonable and necessary information incident to the employment process. I release the Onondaga County Water Authority, any former employers, educational institutions and any other persons giving references, from all liability for damage that may result from use of such information. I am aware that (1) the Onondaga County Water Authority has a drug and alcohol policy that provides for pre- employment testing as well as testing after employment, (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I acknowledge that this application does not create an expressed or implied employment contract.
Please print name*
First Last

Application For Employment

Type of Employment Desired

Education

Employment History