APPLICATION FOR EMPLOYMENT

General Information

Employment Desired

Personal Information

Education, Training and Experience

High School

College/ University

Vocational/ Business

Other

Answer the following questions, if applicable to job applying for:

References

List below three persons not related to you who have knowledge of your work performance within the last three years.

Reference No. 1

Reference No. 2

Reference No. 3

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize Bodega Bay Public Utility District to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further authorize the references I have listed to disclose to Bodega Bay Public Utility District any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Bodega Bay Public Utility District, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and Bodega Bay Public Utility District. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself, or Bodega Bay Public Utility District, and that no promises or representations contrary to the foregoing are binding on the Bodega Bay Public Utility District unless made in writing and signed by me and Bodega Bay Public Utility District’s designated representative.