Position & Date Available
* Position You Are Applying For
Date of Application	Date Available

Name & Address

* First Name

Middle Name

* Last Name

* Present Address

* City

* State

* Zip

Permanent Address Check if same as present address

City

State

Zip

* Main phone

Alternate phone

Email ( if you have an email address )

Education
High School
* High School Name	* Location - include City, State, Zip	* Last Grade Completed
Dates Attended
From	To	Graduation Date

Technical/College/University 1
Name	Location - include City, State, Zip
Major	Minor	Degree
Dates Attended
From	To	Graduation Date

Technical/College/University 2
Name	Location - include City, State, Zip
Major	Minor	Degree
Dates Attended
From	To	Graduation Date

Technical/College/University 3
Name	Location - include City, State, Zip
Major	Minor	Degree
Dates Attended
From	To	Graduation Date

Personal Data

* Have you ever been employed or filed an application
with Beaufort-Jasper Water & Sewer Authority before?
Yes No

If yes, when did you apply or what were your employment dates?

From
To

* Do any of your relatives work here?
Yes No

If yes, what are their names?

* May we contact your present or former employer?
Yes No

* Have you ever been convicted of a felony?
Yes No

If yes, please list the charge, where convicted, date, and disposition.

Conviction of an offense is not an automatic bar to employment. The Authority will consider the nature, date, and relationship between the offense and the position for which you are applying.

* Only U.S. Citizens or Aliens who have a legal right to work in the U.S. are eligible for employment.
Can you, upon employment, provide documentation establishing your identity and eligibility to be legally employed in the U.S.?
Yes No

Are you available to work (please indicate shift or shifts)

Full Time

Shift 1

Shift 2

Shift 3

Part Time

Morning

Afternoon

Evening

Temporary
Dates available

From
To

* What is your desired salary range?

Low

High

Employment Experience
List all employment in chronological order, with present employment first. Any voids in the chronological order must be explained. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. NOTE: Submission of a resume is not sufficient. All applicants must complete this section.

Employer 1

* Employer Name - Current or Most Recent

* Street Address

* City

* State

* Zip

* Telephone Number

* Dates Employed

From
To

* Work Performed

* Job Title

* Hourly Rate / Salary

Starting

Final

* Supervisor Name

* Reason For Leaving

Employer 2

Employer Name

Street Address

City

State

Zip

Telephone Number

Dates Employed

From
To

Work Performed

Job Title

Hourly Rate / Salary

Starting

Final

Supervisor Name

Reason For Leaving

Employer 3

Employer Name

Street Address

City

State

Zip

Telephone Number

Dates Employed

From
To

Work Performed

Job Title

Hourly Rate / Salary

Starting

Final

Supervisor Name

Reason For Leaving

References
Complete the information requested below. You should include individuals familiar with your work who are not relatives or former employers. If selected for employment, these individuals may be contacted as well as former employers.
Name of Reference	Position/Relationship	Mailing Address	Phone Number

Additional Information

Specialized Skills: ( Check Skills / Equipment Operated )

Other Qualifications and Memberships

Summarize special job-related skills, professional licenses, certifications and qualifications acquired from employment or other experiences. Also, list any professional, trade, business or civic activities and offices held. You may exclude memberships which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.

* How did you hear of this job opening?

BJWSA Employee (specify)
Website (specify)
Newspaper (specify)
Other (specify)

Applicant's Statement
I certify that answers given herein are true and complete. I authorize investigation of all statements contained in the application for employment as may be necessary in arriving at an employment decision. I understand that if I am tentatively selected for employment with Beaufort-Jasper Water & Sewer Authority I will be required to submit to various background checks including, but not limited to, reference screening, criminal records checks, driving record checks, a post-offer medical examination and post-offer drug screening. This application for employment shall be considered active for a period of time not to exceed six (6) months or until a hiring decision is made if applying for a specific, vacant position. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with Beaufort-Jasper Water & Sewer Authority may discharge the Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized Executive or Executive Body of the organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
* Digital Signature (required): Typing your name in the box below is the same as a signature on paper.
Name	Date

Applicant's Statement

I certify that answers given herein are true and complete. I authorize investigation of all statements contained in the application for employment as may be necessary in arriving at an employment decision.

I understand that if I am tentatively selected for employment with Beaufort-Jasper Water & Sewer Authority I will be required to submit to various background checks including, but not limited to, reference screening, criminal records checks, driving record checks, a post-offer medical examination and post-offer drug screening.

This application for employment shall be considered active for a period of time not to exceed six (6) months or until a hiring decision is made if applying for a specific, vacant position.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with Beaufort-Jasper Water & Sewer Authority may discharge the Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized Executive or Executive Body of the organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

* Digital Signature (required): Typing your name in the box below is the same as a signature on paper.

Name

Date

Invitation to Voluntary Self-Identify
Invitation to Voluntarily Self-Identify for Armed Forces Service Medal, Recently Separated Veterans, and Other Protected Veterans. (41 C.F.R. §60-300.42 (b) & 41 C.F.R. §60-300. Appendix B) The Beaufort-Jasper Water & Sewer Authority (BJWSA) is subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified individuals who are Armed Forces Service Medal veterans, recently separated veterans, and other protected veterans. If you are in one of these categories, we would like to be included under our affirmative action program. You may inform us of your desire at this time and/or at any time in the future. Submission of self-identifying information is voluntary and refusal to provide it will not subject you to any adverse treatment. Information you submit will be kept confidential except for government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs (OFCCP).
Please review the definitions and check any of the following categories that apply to you: Recently Separated Veteran: Any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service. Armed Forces Service Medal Veteran: Any veteran who, while service on active duty in the U.S. military, ground, naval or air service, participated in the United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 FR 1209). Other Protected Veteran: Any veteran who served on active duty in the U.S. military ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the Department of the Defense. None of the above apply. I understand that this invitation is voluntary in nature and that I elect not to Self-Identify. Please type your full name

Invitation to Voluntary Self-Identify

Invitation to Voluntarily Self-Identify for Armed Forces Service Medal, Recently Separated Veterans, and Other Protected Veterans.
(41 C.F.R. §60-300.42 (b) & 41 C.F.R. §60-300. Appendix B)

The Beaufort-Jasper Water & Sewer Authority (BJWSA) is subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified individuals who are Armed Forces Service Medal veterans, recently separated veterans, and other protected veterans. If you are in one of these categories, we would like to be included under our affirmative action program. You may inform us of your desire at this time and/or at any time in the future. Submission of self-identifying information is voluntary and refusal to provide it will not subject you to any adverse treatment. Information you submit will be kept confidential except for government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs (OFCCP).

Please review the definitions and check any of the following categories that apply to you:

Recently Separated Veteran: Any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service.

Armed Forces Service Medal Veteran: Any veteran who, while service on active duty in the U.S. military, ground, naval or air service, participated in the United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 FR 1209).

Other Protected Veteran: Any veteran who served on active duty in the U.S. military ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the Department of the Defense.

None of the above apply.

I understand that this invitation is voluntary in nature and that I elect not to Self-Identify.

Please type your full name

High School

Technical/College/University 1

Technical/College/University 2

Technical/College/University 3

Employer 1

Employer 2

Employer 3