2. _{SOLANO IRRIGATION DISTRICT
   Human Resources Department
   810 Vaca Valley Parkway, Suite 201} 

   _{Vacaville, CA 95688}

3. _{EMPLOYMENT APPLICATION}

5. Please note:

   • A separate employment application is required for each recruitment.
   • Complete this application in its entirety.  The District reserves the right to reject incomplete or illegible applications.
   • If your answer to a question is “None”, respond to the question as “None” rather than leaving the question blank.
   • Resumes are accepted with application; however, resumes are not a substitute for completing the application in its entirety.
7. 1. Title of the position*
9. 2. Last Name*
10. First Name*
11. Middle Name
13. 3. Other Name(s) (that you have used under which educational or employment records exist):
15. 4: Address*
16. City and State
17. Zip Code
19. 5. Residence Phone Number
20. Cell phone No.
21. Email Address*
23. 7. Are you at least 18 years of age? *

    1. Yes

    1. No
25. 8. Federal laws require that employers hire only individuals who are authorized to be lawfully employed in the United States. In compliance with such laws, all offers of employment are subject to verification of each applicant’s identity and employment authorization, and it will be necessary for you to submit such documents as are required by law to verify your identification and employment authorization upon employment. Are you authorized to work for all employers in the United States on a full-time basis, or only for your current employer? (Solano Irrigation District does not currently sponsor any non-immigrant candidates with any categories of visas.)

    1. All Employers

    1. Current Employers
27. 9. Are you fluent in any language other than English?*

    1. Yes

    1. No
28. If Yes, please specify:
30. 10. EDUCATION
32. Did you graduate from High School?*

    1. Yes

    1. No
33. General Education Diploma or CA Proficiency

    1. Yes

    1. No
35. Name, address and phone number of High School:*
39. NAME OF COLLEGE OR UNIVERSITY CITY, STATE
40. DID YOU GRADUATE COLLEGE/UNIVERSITY?
41. LIST DEGREES OR DIPLOMAS
42. MAJOR STDUDIES (INDIDATE IF ANY)
44. 11. LICENSE AND CERTIFICATION
46. LICENSE/CERTIFICATION
47. CERTIFICATION NUMBER
48. ISSUED BY
49. EXPIRATION DATE

53. 12. EMPLOYMENT HISTORY: Begin with your most recent experience and account for all time during the last ten years, excluding volunteer or non-paid internship experience.  If additional space is required, attach additional sheets.  Attaching a separate resume is recommended but will not be used in lieu of completing this form (your application will be subject to rejection if this section is not completed in full). BE SURE TO LIST EACH CHANGE IN TITLE OR PROMOTION SEPARATELY.

55. NAME OF EMPLOYER:
56. PHONE NO.
58. STREET ADDRESS
59. CITY AND STATE
60. ZIP CODE
62. NAME OF YOUR SUPERVISOR
63. TITLE OF YOUR SUPERVISOR
65. YOUR EXACT JOB TITLE
66. HOURS WORKED PER WEEK:
68. FROM DATE:
    FROM DATE:
69. TO DATE:
    TO DATE:
70. TOTAL YEARS
71. TOTAL MONTHS
73. JOB DUTIES WERE:
75. REASON FOR LEAVING:
77. ARE YOU STILL EMPLOYED ?

    1. Yes
    2. No
78. DID YOU SUPERVISE ?

    1. Yes
    2. No
79. IF "YES" NUMBER OF EMPLOYEES?
83. NAME OF EMPLOYER
84. PHONE NO.
86. STREET ADDRESS
87. CITY AND STATE
88. ZIP CODE
90. NAME OF YOUR SUPERVISOR
91. TITLE OF YOUR SUPERVISOR
93. EXACT TITLE OR POSITION
94. HOURS WORKED PER WEEK:
96. FROM DATE:
    FROM DATE:
97. TO DATE:
    TO DATE:
98. TOTAL YEARS
99. TOTAL MONTHS
101. JOB DUTIES WERE:
103. REASON FOR LEAVING
105. ARE YOU STILL EMPLOYED ?

     1. YES
     2. NO
106. DID YOU SUPERVISE ?

     1. YES
     2. NO
107. IF "YES" NUMBER OF EMPLOYEES?
111. NAME OF EMPLOYER
112. PHONE NO.
114. STREET ADDRESS
115. CITY AND STATE
116. ZIP CODE
118. NAME OF YOUR SUPERVISOR
119. TITLE OF YOUR SUPERVISOR
121. EXACT TITLE OR POSITION
122. HOURS WORKED PER WEEK:
124. FROM DATE:
     FROM DATE:
125. TO DATE:
     TO DATE:
126. TOTAL YEARS
127. TOTAL MONTHS
129. JOB DUTIES WERE:
131. REASON FOR LEAVING
133. ARE YOU STILL EMPLOYED ?

     1. YES
     2. NO
134. DID YOU SUPERVISE ?

     1. YES
     2. NO
135. IF "YES" NUMBER OF EMPLOYEES?
139. NAME OF EMPLOYER
140. PHONE NO.
142. STREET ADDRESS
143. CITY AND STATE
144. ZIP CODE
146. NAME OF YOUR SUPERVISOR
147. TITLE OF YOUR SUPERVISOR
149. EXACT TITLE OF POSITION
150. HOURS WORKED PER WEEK:
152. FROM DATE
     FROM DATE
153. TO DATE
     TO DATE
154. TOTAL YEARS
155. TOTAL MONTHS
157. JOB DUTIES WERE:
159. REASON FOR LEAVING
161. ARE YOU STILL EMPLOYED ?

     1. Yes
     2. No
162. DID YOU SUPERVISE ?

     1. YES
     2. NO
163. IF "YES" NUMBER OF EMPLOYEES?
165. Upload Resume

     Please upload your resume and cover letter in PDF format.

     
     

166. Upload Form

     Please upload all your IDs, educational and certification in one PDF file.

167. Other Documents

     Please use this option any other document that you want to upload.

168. Other Documents

     Please use this option any other document that you want to upload.

     
     

172. 13. Do you possess a valid California Driver’s License?*

     1. Yes

     1. No
173. If yes, what type ?
175. 14. Are you related to any District employee?

     1. Yes

     1. No
176. If “Yes”, please list the names and relationship of each District employee you are related to:
178. 15. Are you currently working at the District?

     1. Yes

     1. No
179. If “Yes” Temporary Worker or Regular Status ?

     1. Temporary Worker

     1. Regular Status
181. 16. Have you previously been employed by the District

     1. Yes

     1. No
182. If “Yes”: please list job titles/
183. Date
     Date Start Date

     —

     Date End Date
185. 17. May we contact your current or most recent employer?

     1. Yes

     1. No
186. If "No" please state the reason:
188. CERTIFICATE OF APPLICANT

     I understand that a job offer from Solano Irrigation District is contingent upon successful completion of pre-placement screening process which may include medical/drug screen and other pre-employment examinations. I hereby certify that all information on this application and any attachments are complete, accurate and true to the best of my knowledge.   I agree and understand that any omission or misrepresentation by me on this application will result in cancellation of my application or termination of my employment.

190. SIGNATURE OF APPLICANT*
191. DATE: *
     DATE:
193. We really appreciate if you complete the Equal Employment Opportunities Questionnaire (EEO Questionnaire):
     EEO Questionnaire
Leave This Blank:


195. 1. Receive an email copy of this form.
196. Email address

     This field is not part of the form submission.

197. Submit Submit and Print

* indicates a required field