Online Application

Position

Date*

Position Applying For

Department

Town

Pay Expected

Date Available for Work

How did you learn about this job opportunity?

In-House
News Paper
Friend
Internet
Other

Other

Name*

First Last

Address

Street Address City State ZIP Code

Email*

Phone

Have you ever been bonded?

Yes
No

Current Employer(s)

Are you currently a district employee?

Yes
No

Department

May we contact you at work?

Yes
No

Work Number

Personal Information

Education Record

Type of School	School Name	Location	Hours Earned	Diploma, Degree Certificate	Major Field of Study

Do you have a High School diploma or GED?*

District policy requires applicants to have a GED or High School diploma.

Yes - High School diploma
Yes - GED
No

Licenses

List Drivers License and other current licenses, certifications, or registrations required for the position for which you are applying. One per line please.

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(s) can you clearly communicate?

Have you previously worked for the district?

Yes
No

When did you work for the district?

Which department?

Is a relative of yours a board member or currently employed by the district?*

Yes
No

Please provide that person's 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.

Yes
No

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 & References

Acknowledgements*

Please read ALL of the following statements and CHECK each box 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.

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

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. DO NOT use references such as ‘See Resume’ in place of completing this section.

Employer 1

Employer Name

Phone

Address

Street Address Address Line 2 City State ZIP Code

From

To

Designation

Full Time
Part Time

Position

Starting Salary

Ending Salary

Related Duties

Supervisor's Name and Title

Reason for Leaving

May we contact this employer for reference?

Yes
No
Later

When?

Employer 2

Employer Name

Phone

Address

Street Address Address Line 2 City State ZIP Code

From

To

Designation

Full Time
Part Time

Position

Starting Salary

Ending Salary

Related Duties

Supervisor's Name and Title

Reason for Leaving

May we contact this employer for reference?

Yes
No
Later

When?

Employer 3

Employer Name

Phone

Address

Street Address Address Line 2 City State ZIP Code

From

To

Designation

Full Time
Part Time

Position

Starting Salary

Ending Salary

Related Duties

Supervisor's Name and Title

Reason for Leaving

May we contact this employer for reference?

Yes
No
Later

When?

Employer 4

Employer Name

Phone

Address

Street Address Address Line 2 City State ZIP Code

From

To

Designation

Full Time
Part Time

Position

Starting Salary

Ending Salary

Related Duties

Supervisor's Name and Title

Reason for Leaving

May we contact this employer for reference?

Yes
No
Later

When?

Employer 5

Employer Name

Phone

Address

Street Address Address Line 2 City State ZIP Code

From

To

Designation

Full Time
Part Time

Position

Starting Salary

Ending Salary

Related Duties

Supervisor's Name and Title

Reason for Leaving

May we contact this employer for reference?

Yes
No
Later

When?

Substance Abuse Policy

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 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.

Date*

APPLICANT/EMPLOYEE*

Please type your full name to serve as your digital signature.

Disclosure Authorization & Release Form

I, 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.

Date*

APPLICANT/EMPLOYEE*

Please type your full name to serve as your digital signature.