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Home
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2020 Water Quality Report
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Name
*
First
Last
Date of Birth
*
MM slash DD slash YYYY
Social Security Number
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Home Phone
*
Cell Phone
Email
*
Are you legally allowed to work within the United States?
*
Yes
No
Do you have a valid Driver's License?
*
Yes
No
License Number
*
Date Issued
MM slash DD slash YYYY
Expiration Date
MM slash DD slash YYYY
Issuing State
Do you hold a drivers license with a CDL Endorsement?
Yes
No
Do you hold a drivers license with a Class A Endorsement?
Yes
No
Do you hold a drivers license with a Class B Endorsement?
Yes
No
Do you hold a drivers license with a Class C Endorsement?
Yes
No
Do you hold a drivers license with a Class D Endorsement?
Yes
No
Do you presently have traffic violation points against your driver license?
Yes
No
How many?
Do you suffer from habitual drunkeness or from narcotics addiction or dependence?
*
Yes
No
Are you of good moral character?
Yes
No
Have you ever been convicted of a felony in this state or any other state or territory?
*
Yes
No
Please explain what kind and any circumstances you wish to share.
Position Applied For:
*
Are you available full time?
*
Yes
No
Are you available for rotating shifts?
*
Yes
No
Are you available part time?
*
Yes
No
What days and hours are you available for work?
*
Start Date
*
MM slash DD slash YYYY
Have you ever applied before?
Yes
No
When?
MM slash DD slash YYYY
Have you ever served in the U.S. Military or Naval
Yes
No
Rank
Education
Education
*
High School
Partial College
College
Other
Name of High School
Year Completed
Diploma
*
Name of College
Year Completed
Diploma
Other Education
Year Completed
Diploma or Certificate
Employment History
(Start with your present/most recent job.)
1st Company Name:
*
1st Company Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
1st Company Phone:
*
1st Supervisor's Name:
*
First
Last
1st Company Date Hired:
*
MM slash DD slash YYYY
1st Company Date Left:
*
MM slash DD slash YYYY
Weekly Pay Rate:
*
(List starting and ending Pay Rate)
Description of Job Duties:
*
Job Title:
*
Reason for Leaving:
*
2nd Company's Name:
2nd Company's Address:
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
2nd Company's Phone:
2nd Supervisor's Name:
First
Last
Employed To - From:
Weekly Pay Rate:
(List starting and ending pay rates)
Describe Job Duties:
Job Title:
Reason for Leaving:
Do you have any other special training, certifications, or professional licenses?
Personal References
1st Reference Name:
*
1st Reference Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
1st Reference Phone:
*
2nd Reference Name:
*
2nd Reference Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
2nd Reference Phone:
*
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
*
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.
Home
Bill Pay
Service Info
Establishing Service
Reading Your Bill
Water Metering
Identifying Our Employees
Discontinuing Service
Water Info
Water Use Statistics
Winter Preparation
Water Conservation Tips
Drought Fact Sheet
Water and Your Health
CDC Recommendation for Reopening Business or Building
Customer Service
Forms
Start Service
End Service
Transfer Location
Change of Mailing Address
Documents
CCR
2020 Water Quality Report
2019 Water Quality Report
2018 Water Quality Report
2017 Water Quality Report
Achievements
Contact
Join Our Team
