Job Application Please enable JavaScript in your browser to complete this form.123456789Applicant InformationName *FirstMiddleLastAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Alternate PhoneEmail *Have you ever applied for employment with us? *YesNoIf yes, when did you apply? *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Position(s) Desired *NO POSITION AVAILABLEPay Expected *HourlyWill you work overtime if asked? *YesNoWhen will you be available to begin work? *Two weeks after job offerSpecific DateOtherSpecific Availability Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Other Availablity *How did you learn of our organization? *What are your special trainings or skills? *NextEducationSelect EducationCollegeHigh SchoolElementary SchoolOtherCollegeName *Location *Course of Study *Number of Years Completed *Did you graduate? *YesNoN/ADegree or Diploma? *High SchoolName *Location *Number of Years Completed *Did you graduate? *YesNoN/ADegree or Diploma? *Elementary SchoolName *Location *Number of Years Completed *Other EducationName *Location *Course of StudyNumber of Years Completed *Did you graduate? *YesNoN/ADegree of Diploma?MembershipsList memberships if professional or civic organizations.Exclude those which may disclose your race, color, religion, or national origin.NextEmployment HistoryPlease give your accurate, complete full-time and part-time employment record. Start with present or most recent employer.How many employers have you worked for? *Employer #1Company Name *PhoneAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre you still employed? *YesNoEmployment Date Started *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employment Date Ended *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of SupervisorYour Job Title *Description of Work Performed *Reason for Leaving *May we contact this employer? *YesNoList the reason(s) why we cannot contact this employer. *Employer #2Company Name *PhoneAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre you still employed? *YesNoEmployment Date Started *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employment Date Ended *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of SupervisorYour Job Title *Description of Work Performed *Reason for Leaving *May we contact this employer? *YesNoList the reason(s) why we cannot contact this employer. *Employer #3Company Name *PhoneAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre you still employed? *YesNoEmployment Date Started *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employment Date Ended *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of SupervisorYour Job Title *Description of Work Performed *Reason for Leaving *May we contact this employer? *YesNoList the reason(s) why we cannot contact this employer. *All Other EmployersList all other employers and relevant information. *NextDriving RecordDriver LicenseHow many driver licenses do you possess? *License #1State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLicense Number *Type *ClassExpiration Date *License #2State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLicense Number *Type *ClassExpiration Date *All Other LicensesList all other driver licenses and relevant information. *Driving ExperienceSelect the classes of equipment you have experience with.Straight TruckTractor & TrailerBusAutomobileOtherStraight TruckType of Equipment *Van, truck, flatbed, etc.Number of Years Experience *Total Approximate Miles Driven *Tractor & TrailerType of Equipment *Van, truck, flatbed, etc.Number of Years Experience *Total Approximate Miles Driven *BusType of Equipment *Van, truck, flatbed, etc.Number of Years Experience *Total Approximate Miles Driven *AutomobileType of Equipment *Van, truck, flatbed, etc.Number of Years Experience *Total Approximate Miles Driven *OtherType of Equipment *Van, truck, flatbed, etc.Number of Years Experience *Total Approximate Miles Driven *Safe Driving AwardsDo you have any safe driving awards? *YesNoList your safe driving awards and whom they are from. *Accident RecordHow many accidents have you been involved in within the last three years? *Accident #1Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nature of Accident *Who is at fault? *Accident #2Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nature of Accident *Who is at fault? *All Other AccidentsList all other accidents and relevant information. *Traffic Convictions and ForfeituresHow many traffic convictions and forfeitures have you had within the last three years? *Do not include parking violations.Conviction #1Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920City *State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCharge *Penalty *Conviction #2Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920City *State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCharge *Penalty *All Other ConvictionsList all other convictions and relevant information. *Have you ever been denied a license, permit, or privilege to operate a vehicle? *YesNoHas any license, permit, or privilege ever been suspended or revoked? *YesNoGive a statement listing details of the denials and/or suspensions. *DMV RecordUpload a current DMV printout (within the last three months). *NextReferencesState the names of three persons who are willing to provide professional and/or character references for you.Reference #1Name *AddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Reference #2Name *AddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Reference #3Name *AddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *NextThe information requested below is needed for a legally permissible reason, including, without limitation, national security considerations, a legitimate occupational qualification or business necessity. The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex, or national origin. Federal law also prohibits discrimination on the basis of age with respect to certain individuals. The laws of most states also prohibit some or all of the above types of discrimination as well as some additional types such as discrimination based upon ancestry, marital status or physical or mental handicap or disability, genetic information, gender identity, gender expression or Military and Veteran status.Are you 18 years of age or over? *YesNoIf not, employment is subject to verification of minimum legal age.Can you perform the essential functions of the job for which you are applying with or without reasonable accommodations? *YesNoSouth San Joaquin Irrigation District is an equal opportunity employer which does not discriminate on the basis of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, or military and veteran status. California Government Code § 12940 et seq.NextTo Be Read and Signed By ApplicantI understand that the information on this application will be used, and that prior employers will be contacted, for purposes of investigation as required by Section 391.23 of the Federal Motor Carrier Safety Regulations. I hereby declare the information provided by me in this Application for Employment is true, correct and complete to the best of my knowledge. I understand that if employed, any misstatement or omission of fact on this application shall be considered cause for dismissal. Further, I agree to furnish such additional job-related information and complete such job-related examinations as may be required. I agree and understand that this application for employment in no way obligates the employer to employ me. I understand this application is not a contract and cannot create a contract. I understand that if accepted by the District, my employment will be on a 12-month probationary basis. The introductory period will be extended by a like number of work days as a result of any leaves of absence, holiday period and other absences occurring during the probation period. If employed by the District, I agree to abide by its rules and regulations. I certify that this application was completed by me, and that all entries on it and information in it are true and complete as to the best of my knowledge.NextAcknowledgement of Pre-Employment Physical Including Routine Drug TestingThe undersigned is an applicant for employment with the South San Joaquin Irrigation District. The applicant has been advised of and understands that, in connection with said application, South San Joaquin Irrigation District requires a pre-employment physical examination, the results of which will be provided to the District in order to determine applicant’s physical ability to perform the required work. Applicant further understands that included within said pre-employment physical is a drug screen intended to determine the presence of any substances present in applicant that are legally controlled or which otherwise might impair applicant’s ability to perform the work. Applicant further understands that the results of said drug screen will be provided to the District as part of its review of applicant’s employability. Applicant herewith consents to the administration of the above described physical examination, and concurrently herewith authorizes release of said information to South San Joaquin Irrigation District as necessary to determine suitability for employment.NextYour Application Will Be Considered Active For 30 DaysU.S. law requires that, if hired, you must furnish your Social Security Card* and one of the following documents within 72 hours of starting work: A card issued by Federal, State or local government showing your identity Driver’s license, or State issued ID card with photo ID School ID card with photo Current INS Forms with employment authorization stamp U.S. passport Voter’s registration card U.S. military card or other draft card *If you do not have a Social Security Card, you may present an original or copy of a U .S. birth certificate, or Department or State Forms FS-545 or DS-1350 or INS Forms 1-327,1-571,1-197, 1-179.Upload any other relevant documents.This may include your resume, cover letter, etc.Submit