CLAY COUNTY UTILITY AUTHORITY

APPLICATION FOR EMPLOYMENT

PLEASE READ THIS APPLICATION THOROUGHLY AND COMPLETE IT HONESTLY. CLAY COUNTY UTILITY AUTHORITY (“CCUA”) PERFORMS A DETAILED BACKGROUND INVESTIGATION ON ALL FINAL CANDIDATES.

IMPORTANT NOTICE: If you need assistance in completing this application, please contact the Human Resources Director. Applicants should be careful as they complete this application. Should it be determined that the application contains any inaccurate or incomplete information, it will result in disqualification from employment with the company, or in termination if the inaccuracies are discovered subsequent to your employment with CCUA.

CCUA is an equal opportunity employer and will not discriminate against any employee or applicant for employment on the basis of race, color, religion, origin, disability, age, marital or veteran status or in any manner prohibited by law. If you feel you have been unfairly treated or discriminated against for any reason, please call this to the attention of the Director of Human Resources so that we may address your concerns.

Employment is conditioned on the successful completion of CCUA’s screening process. This may include a detailed background check. By signing this application, I represent that the information provided in this form is given voluntarily, may be used in filing reports required by state and federal governments and agencies, may be disclosed to others, and may be used for any other purpose not prohibited by law. CCUA requires all individuals who successfully complete the initial employment screening process to submit to a drug screening program, which may include the taking of blood and/or urine samples, and requires/reserves the right to require that all employees submit to drug and alcohol testing during the course of their employment, in accordance with CCUA’s current drug testing policy. The result of such screening/testing will be initially disclosed to decision makers of CCUA and may be the basis for disqualifying any candidate for employment and for termination during employment. CCUA reserves the right to utilize this information in any way it deems necessary, such as but not limited to civil, criminal and administrative proceedings, and any other similar matters. By signing this application, I agree to the foregoing and further agree to hold CCUA harmless for any claims resulting from such screening/testing for drug and/or alcohol use.

NOTE: All applicants will be required to furnish proof of identity, high school diploma from an accredited school, and legal work authorization to be considered for employment.