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Do you suffer from habitual drunkeness or from narcotics addiction or dependence?
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Have you ever been convicted of a felony in this state or any other state or territory?
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Please explain what kind and any circumstances you wish to share.
Position Applied For:
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Are you available full time?
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Are you available for rotating shifts?
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Do you have any other special training, certifications, or professional licenses?
Personal References
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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:
Yes, you may contact my current employer.
No, you may not contact my current employer.
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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I do swear/confirm that the above answers given are true and correct. I understand responses given are subject to verification by Beckley Water Company.
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