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Step One

Champlain Water District Employment Application
Fields with an asterisk (*) are required
1. GENERAL INFORMATION/WORK PREFERENCE
Position for which you are applying*
Expected Pay
If you were referred by a CWD employee, please tell us by whom
2. PERSONAL INFORMATION
Last Name*
First Name*
M.I.
Today's Date
Today's Date
Street or P.O. Box*
City*
State*
Zip Code*
Your Email Address*
Preferred Phone Number
3. WORK EXPERIENCE
Describe Prior Experience or Skills Related to the Type of Work Desired
Describe any specialized training | apprenticeships | internships
Technology | Equipment Skills (computer software, machines, etc.)*
If you are responding to an ad, where did you see it?
1. CWD Website
2. Indeed.com
3. VLCT Job Posting
1. GMWEA
2. Other Source (Please Name)
Online / Print Ad Specified
Other Source Specified
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5. EDUCATION & TRAINING
If this information is included on an attached resume, you may skip this section.
High School (Name of School)*
Last Grade Completed*
Vocational (name of school)
Level Completed*
University | College (Name of School)
Level Completed
Diplomas | Degrees (Check all that apply)*
1. HS Diploma / GED
2. Associate's Degree
3. Masters Degree
1. Certification
2. Bachelor's Degree
1. Doctorate
2. License
Specify:
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6. EMPLOYMENT & U.S. MILITARY SERVICE RECORD
Please complete this section even if you have attached a resume. Give a complete account of employment. Begin with your present or most recent positions and work backward in time.
1. Employer's Name & Address
Supervisor's Name
Phone
Last position held
Responsibilities/Duties
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Reason for Leaving?
2. Employer's Name & Address
Supervisor's Name
Phone
Last position held
Responsibilities/Duties
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Reason for leaving?
3. Other Positions
Employer
Responsibilities/Duties
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Reason for leaving?
Are you a veteran of the US military service?
1. Yes
2. No
If so, Branch
Dates Served
Dates Served Start Date
—
Dates Served End Date
Military training | experience relevant to position applied for:
7. ATTACH COVER LETTER AND RESUME*
PDF format only.
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7. STATEMENT OF AFFIRMATION (Read Carefully Before Signing)*
By entering my name and date below I hereby affirm that the information I have provided on this application is true and accurate to the best of my knowledge. I authorize the verification of any or all of the information I have provided and any inquiries permissible by law to determine my suitability for employment. I understand that omissions or misrepresentations may be cause for rejection or, If I am hired, may be just cause for immediate dismissal.
Applicant's Signature*
Date
Date
* indicates a required field
Champlain Water District is an Equal Opportunity Employer. It is the policy of the District to provide equal employment opportunity to all applicants and employees without regard to race, color, religion, gender or sexual orientation, age or any other status protected by state or federal law.

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