Water Utility Internship

Positions Requested (check all that apply)

Wastewater Utility Internship

Last Name

First Name, Middle Initial

First Name *

Middle Initial *

Phone Number

Email Address

If hired, when could you begin work?

Tennis positions are typically 3-6 hours per week and Parks, Splash Pad and Day Camp are typically 40 hours per week.

How many hours do you want to work each week?

Are you legally eligible for employment in the United States? (If hired, you will be required to provide proof of work autorization.)

Are you 18 years of age or older?

If no, list your date of birth.

Are you able to perform all essential functions/duties of the position for which you are applying?

If no, please identify which essential functions you could perform with reasonable accommodation:

Have you ever been convicted of a misdemeanor, gross misdemeanor or felony or do you currently have a pending criminal charge against you?

Conviction record(s) or pending arrest record(s) do not constitute an automatic bar to employment and will be considered only if there is a substantial relationship to the circumstances of the particular position or if the employer deems there is a bona fide occupational qualification inherent in the position.

Please explain and include dates

Work Experience and Education

Which school did you most recently attend?

Name *

City *

State *

Major

Last Year Completed/Degree Earned.

Employer 1 Name & Address

Employer 1 Position and Duties

Employer 1 Dates of Employment

Start Date

End Date

Employer 1 Supervisor

Name

Title

Phone

Reason for Leaving Employer 1 or Seeking Other Employment

May We Contact Employer 1?

Employer 2 Name & Address

Employer 2 Position and Duties

Employer 2 Dates of Employment

Start Date

End Date

Employer 2 Supervisor

Name

Title

Phone

Reason for Leaving Employer 2 or Seeking Other Employment

May We Contact Employer 2?

Employment References

List individuals familiar with your job qualifications. No relatives or personal friends.

Employment Reference 1

Name

Relationship

Phone

Employment Reference 2

Name

Relationship

Phone

Applicant’s Authorization & Acknowledgement<br> I certify that the information provided on this application is true, correct and complete to the best of my knowledge without omissions of any kind. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be justification for dismissal if discovered at a later date. I authorize persons, schools, my current employer (if applicable) and previous employers and organizations named in this application (and accompanying documentation, if any) to provide any relevant information to the Village of Sussex that may be required to enable the Village of Sussex to arrive at an employment decision. I release the Village of Sussex and all providers of information from any liability as a result of furnishing and receiving any information related to the Village of Sussex hiring process. I acknowledge that a full background check may be run as related to any police records and/or driving records. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the Village of Sussex is of an at will nature. I understand that if I am hired, I am required to abide by all rules and regulations of the Village of Sussex. I understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the Village.

I agree

I do not agree

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.