Application Employment Application Employment Application Position and Applicant Info: Date of Application: * Position Applied For: * Name: * Address: * Phone * Email * How did you hear about us? List specific source: * Employment Related Data: Are you over the age of 18 years? (If no, you may be required to provide authorization to work): * Yes No Are you legally eligible for employment in the U.S.? (Verification may be required upon employment): * Yes No Have you worked for the ACSA in the past? If so, when and in what position * Do you have any relatives currently employed by the ACSA? If so, please list employee name and position/department: * Have you been convicted of a felony within the last 7 years? (Please exclude convictions that have been sealed, expunged, or legally eradicated. A conviction is not an automatic bar to employment and each case will be considered on its own merits.) If yes, state the nature of the offense(s), the date and court where convicted, and the case disposition: * Do you have a valid driver's license? If yes, give State and License Number. (If the position for which you are applying requires operation of a motor vehicle, the ACSA will obtain your driving records from the Virginia Department of Motor Vehicles; if your license is from another State you will be required to provide the same. Your signature on this application authorizes the ACSA to obtain this information in consideration of employment.) * Educational Background: High School * Number of years Attended? Did you graduate? Yes No Degree/Major: College Number of years Attended? Did you graduate? Yes No Degree/Major: Post-Graduate Number of years Attended? Did you graduate? Yes No Degree/Major: Business or Trade Number of years Attended? Did you graduate? Yes No Degree/Major: Certifications: Have you completed any special courses, seminars and/or training that would enable you to perform the position for which you are applying? (If yes, please describe in full): References: Professional Reference #1: * Professional Reference #2: * Professional Reference #3: * If you believe that we need additional information in order to evaluate your application for employment, please use the space below: Work History: (List work history, beginning with the most current employment) 1. Most Recent Employer: * 2. 3. Please indicate any employers listed above that you do NOT wish to be contacted: Upload Resume and/or any supporting documentation: Drop a file here or click to upload Choose File Maximum upload size: 516MB Note: Albemarle County Service Authority is an Equal Opportunity Employer. It is the policy of this organization to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, sexual orientation, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local Law. CERTIFICATION AND AGREEMENT- PLEASE READ CAREFULLY! If hired, I agree to abide by all ACSA rules and regulations, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the ACSA or me; I further understand that no representation, whether oral or written by any representative or agent of the ACSA, at any time, can constitute a contract of employment. Further, my signature below certifies that the facts set forth in this employment application are true and complete to the best of my knowledge. As a part of this application, I am signing authorization for the ACSA and its representative, HireRight and/or Applicant Insight, to obtain information regarding my background. I understand that unsigned applications will not be considered and, if I am employed, falsified statements on this application, failure to reveal any prior employer, or giving false or misleading information by me on any part of this Application for Employment can be considered sufficient cause for dismissal. * Date Application Signed: * Submit If you are human, leave this field blank.