EMPLOYMENT APPLICATION
Preble Soil and Water Conservation District
1651 North Barron Street
Eaton, OH 45320
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Last Name First Middle Initial
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Date |
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Street Address
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Home Telephone |
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City, State, Zip
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Other Telephone |
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Have you ever applied for employment with another SWCD? £ Yes £ No If Yes; Month and Year _____ Location ______________ |
Social Security # |
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Position Desired |
Pay Range Desired |
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Apart from absence for religious observance, are you available for full-time work? £ Yes £ No If not, what hours can your work? |
Will you work overtime if asked? |
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Are you legally eligible for employment in the United States?
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When will you be available to begin work? |
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Other special training or skill (machines, computer software, public speaking, etc.) |
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School |
Name and Location of School |
Course of Study |
No. of Years Completed |
Did You Graduate? |
Degree Or Diploma |
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Graduate |
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College |
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Business/ Trade/ Technical |
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High School |
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Membership in Professional or Civic Organizations (Exclude those which may disclose your race, color, religion or national origin) |
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The Preble Soil and Water Conservation District is an equal employment opportunity employer. All
employment decisions are made without regard to race, sex, age, color, national origin, religion, or disability.
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EMPLOYMENT |
Please give accurate, complete full-time and part-time employment record. Start with your present or most recent employer. |
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Company Name
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Telephone |
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Address |
Employed – (State month and year) From To |
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Name of Supervisor |
Weekly Pay Start Last |
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State Job Title and Describe Your Work
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Reason for Leaving |
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Company Name
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Telephone |
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Address |
Employed – (State month and year) From To |
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Name of Supervisor |
Weekly Pay Start Last |
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State Job Title and Describe Your Work
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Reason for Leaving |
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Company Name
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Telephone |
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Address |
Employed – (State month and year) From To |
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Name of Supervisor |
Weekly Pay Start Last |
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State Job Title and Describe Your Work
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Reason for Leaving |
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Company Name
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Telephone |
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Address |
Employed – (State month and year) From To |
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Name of Supervisor |
Weekly Pay Start Last |
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State Job Title and Describe Your Work
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Reason for Leaving |
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MILITARY |
Are you currently a member Of the United States Military? YES No |
If "Yes", in what Branch? |
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If you served or are now serving in the military, describe any training received relevant to the position for which you are applying.
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Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court? £ Yes £ No If "Yes" describe in full. |
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List agricultural and other related experience not listed above :
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REFERENCES: List name, address, and telephone of three references and years known (not relatives):
1._________________________________________________________________________________
2._________________________________________________________________________________
3._________________________________________________________________________________
At Will Employment. I acknowledge that if hired, I will be an at will employee. I will be subject to dismissal or discipline without notice or cause, at the discretion of Preble Soil and Water Conservation District. I understand that no representative of Preble Soil and Water Conservation District, Other than the current board of supervisor chairperson, has authority to change the terms of an at will employment and that any such change can occur only in a written employment contract. _______ Initials
Authorization. I authorize release of employment, salary, education, and other related records to Preble Soil and Water conservation District for the purpose of checking my references and verifying my employment and educational history. Further, I release former employers and other organizations from any liability for providing this information. __________ Initials
Accuracy. I verify that the statements I have made in this application are true and complete. I understand that if I am hired, any false or incomplete statements in this application will be grounds for immediate discharge.
__________ Initials
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Date Signature of Applicant