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Employment Application

We would love to hear from you! Please fill out this form and we will get in touch with you shortly.

"*" indicates required fields

Name*
MM slash DD slash YYYY
Address*
Do you have a valid Driver's License?*
Are you legally allowed to work within the United States?*
MM slash DD slash YYYY
MM slash DD slash YYYY
Currently Hold a:
Do you presently have traffic violation points against your driver license?
Do you suffer from habitual drunkeness or from narcotics addiction or dependence?*
Are you of good moral character?
Have you ever been convicted of a felony in this state or any other state or territory?*
Are you available full time?*
Are you available for rotating shifts?*
MM slash DD slash YYYY
Have you ever applied before?
MM slash DD slash YYYY
Have you ever served in the U.S. Military or Naval

Education

Highest Level Completed

Employment History

(Start with your present/most recent job.)
1st Company Address:*
Supervisor's Name:*
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MM slash DD slash YYYY
(List starting and ending Pay Rate)

Company's Address:
Supervisor's Name:
(List starting and ending pay rates)

Personal References

Address:*

Address:*

Confirmation

I understand that in processing my application with Beckley Water Company, an investigative consumer report may be conducted to obtain and verify information relating to my past activities and background. Information may include, but not limited to; employment history, education, criminal records, credit history, motor vehicle records, personal references, and any data provided on this application, or during the interview process.
If currently employed: My current employer may be contacted:
I authorize the appropriate individuals, companies, institutions or agencies to release information, and I release them from any liability as a result of such inquires or disclosures. I further understand and waive my right of privacy in this investigation and release and hold harmless Beckley Water Company and its agents, from any liability. An investigative consumer report may be generated summarizing this information. I have a right under the "Fair Credit Reporting Act" to obtain a copy of this report. I hereby certify that all the statements and answers set forth on the application form and/or my resume are true and complete to the best of my knowledge, and I understand that if any statements and/or answers are found false or the information has been omitted, such false statements or omissions may be cause for rejection or termination of my employment or application.
Confirmation*

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119 S. Heber St.
Beckley, WV 25801
304.255.5121
304.255.5134

Emergency Phone Number (8am – 4:30pm) 304.255.5121
Emergency After Hours (After 4:30pm) 304.763.2691

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