Overton Power District #5
Date: (MM/DD/YY) Position Applying For:
Department: Town:
Pay Expected: Date Available for Work: (MM/DD/YY)
How did you learn about this job opportunity?
   Other  
Name: *  
Address:
City:
State:
Zip Code:
Email: *
Telephone No:  

Have you ever been bonded? If yes give employer(s)
Are you a current district emp? If yes what dept
May we contact you at work? If yes work number  




 EDUCATION RECORD
                                                          
                   School Name Location Hours Earned Diploma, Degree Certificate Major Field of Study
High School:
Business/Technical:
College/University:
Graduate School:
District policy requires applicants to have a GED or High School diploma. Please check Yes if you have a GED or High School diploma or No if you do not. Do you have a High School diploma? 

         If Yes, Which?    

For positions which require high school graduation, a GED, or a college degree, a copy of the high school diploma/GED certificate or college
diploma may be required.


APPLICANT NAME:            

POSITION APPLIED FOR:   


LICENSES

List Drivers License and other current licenses, certifications, or registrations required for the position for which you are applying. Indicate
types, state license numbers and expiration dates




SKILLS

List any special skills you possess which may pertain to this position, and/or equipment or office machines you can operate.



LANGUAGE
"(Other than English), in which language can you clearly communicate?


OTHER INFORMATION

If you are not a current District Employee, have you previously worked for the District?

             If yes, When and what department  

Is a relative of yours currently employed by the District?     Name  

During the last ten years, have you been convicted of, pled guilty or nolo contrende to, or been granted deferred adjudication for a
felony or any lesser crime which may be directly related to your qualification for this job?
(Example: Conviction for reckless driving may not be related to your qualifications for a clerical position in the Public Works department,
but could be related to your qualifications for a road maintenance worker.)




If Yes, list all such offenses and give date, name of court and disposition. You may omit minor violations for which you paid a fine of $50 or less





ACKNOWLEDGEMENTS:

Please read ALL of the following statements and INITIAL each line to indicate you have read and understood each
of the statements. If you have any questions, contact Overton Power District #5 Human Resources (702)397-3030.

1. Following an offer of employment, you will be required to submit verification of your legal right to
work in the United States.

2. All offers of employment and all information regarding compensation and other terms and
conditions will be made in writing. Verbal statements may not be relied upon.

3. Employment will be at will unless specifically stated to be otherwise. At Will means the District
has no obligation to continue my employment in the future.

4. This application is the property of the District and will become part of my personnel file, if I am hired.

REFERENCES:
List three school or personal references not related to you.

Name Telephone Year Known

EMPLOYMENT HISTORY

Provide information regarding all paid, military, and volunteer work. Describe your most recent position first;
then list other positions in order, working down from the most recent. Use a separate block for each position-even,
though with the same organization. Explain any gaps in employment. Use additional sheets if necessary.
DO NOT use references such as 'See Resume' in place of completing this section.

Present Employer: Telephone:
 
Address:
From:
(MM/DD/YY)
  		To:
City: State:
Zip:
 
Full Time(30+): or Part Time:
Position:
Starting Salary: Ending Salary:
Supervisors Name and Title:
Related Duties:
Reason For Leaving:
May we contact this employer for reference?
                 


Previous Employer: Telephone:
 
Address:
From:
(MM/DD/YY)
  		To:
(MM/DD/YY)
 
City: State:
Zip:  
Full Time(30+): or Part Time:
Position:
Starting Salary: Ending Salary:
Supervisors Name And Title:
Related Duties:
Reason For Leaving:
May we contact this employer for reference?
                 


Previous Employer: Telephone:
 
Address:

From:

(MM/DD/YY)
 
To:

(MM/DD/YY)
 
City: State:
Zip:
 
Full Time(30+): or Part Time:
Position:
Starting Salary: Ending Salary:
Supervisors Name and Title:
Related Duties:
Reason for Leaving:
May we contact this employer for reference?
                 

I understand that an investigation may be made in which information is gathered regarding my character, previous employment, education background, criminal
history, and other qualifications for employment with Overton Power District #5. I authorize anyone possessing this information to furnish it to the District upon
request, and furnishing, obtaining or using this information.


I certify that all statements are true to the best of my knowledge and I agree and understand that any misstatements or omissions of material facts on my part may
forfeit my participation in the selection process and/or my right to employment, even if discovered after I have become an employee of Overton Power District #5.

Questions?

Call Overton Power District #5 Human Resources at (702) 397-3030 Interview accommodations for disabled applicants can be arranged by calling the Human Resources
Department at 702-397-3030.




            OVERTON POWER DISTRICT # 5 HUMAN RESOURCES/RISK MANAGEMENT


     SUBSTANCE ABUSE POLICY RELEASE FORM


I have been informed that, as a condition of any offer of at-will employment or as a condition of my continued at-will employment, I must submit to a urine, hair and/or blood drug screening test and I accept this condition. I agree that any drug testing facility is authorized by me to provide the results of this test(s) to OVERTON POWER DISTRICT #5 HUMAN RESOURCES/RISK MANAGEMENT. I agree to indemnify and hold the District harmless from and against any and all liabilities or judgments arising out any claim related to

(i) The employer's submission and handling of the test(s) samples,

(ii) Compliance by employer with federal and state law, or

(iii) The employer's interpretation, use (including employment decision) and confidentiality to the test results; except where the testing facility is found to have acted negligently with respect to such matters.

I understand that if I fail to cooperate with a testing procedure, or in the case of a positive test result,
I may not be employed by OVERTON POWER DISTRICT #5 HUMAN RESOURCES/RISK MANAGEMENT or my employment may be terminated by OVERTON POWER DISTRICT #5 HUMAN RESOURCES/RISK MANAGEMENT.

(MM/DD/YY)                                         
DATE                                                                                                                                                        APPLICANT/EMPLOYEE


Disclosure Authorization & Release Form


I, * (print name), authorize Overton Power District #5 to contact any employer or individual that I have listed on my employment application and/or resume or mentioned in job interviews, and to obtain from them any relevant information regarding my previous employment, education, certificates, licenses, military service, criminal history, characteristics or traits, or other qualifications for employment with Overton Power District #5.

In exchange for Overton Power District #5's consideration of my employment application, I authorize anyone possessing this information to furnish it to the District upon request, and I release the individual company or institution and all individuals providing the information or acquiring the information, including the District, from all claims, liability, and damages whatsoever in furnishing, obtaining, or using said information including, but not limited to, claims for defamation, libel, slander, infliction of emotional distress, and interference with current or prospective economic relations.

* *(MM/DD/YY)
Name of Applicant Date