Serving Our Community Since 1902

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1 Serving Our Community Since Laurel Street, Menlo Park, California (650) (650) FAX PHIL SCOTT District Manager February 13, 2018 In reply, please refer to our File No. RE: FIELD SUPERVISOR EMPLOYMENT APPLICATION PACKET Dear Applicant: Thank you for your interest in the Field Supervisor position with the District. The monthly salary range for this position is 5,708-8,705. Applicants need a satisfactory driving record and will participate in the California Department of Transportation (DOT) drug and alcohol testing program requirements on a continual basis. The District is a Union Agency Shop with the Teamsters Local Union No. 350, Sanitary Truck Drivers and Helpers. The Field Supervisor position falls under the classification to pay monthly union dues currently Enclosed you will find the following forms to be completed and important information for your review: Employment Application NOTE: Do not write, See Resume on Page 2. It is required to complete the employment history. The salary is only to be listed for previous employment with a public agency. You may submit a resume and cover letter with your application. Supplemental Questionnaire NOTE: It is required to complete and return the 2-page questionnaire with your application. Employment References Sheet DMV Request Form TAKE ATTACHED REQUEST FORM DIRECTLY TO DMV Driver License / ID Record. NOTE: It is your responsibility to obtain a 10-year driving record dated no more than 30 days old and submit with your completed application. Job Description Benefits Summary Complete and return Complete and return Complete and return Obtain an original driving record from the DMV and return Keep for your records Keep for your records RETURN ORIGINAL APPLICATION FORMS INCLUDING AN ORIGINAL DMV DRIVING RECORD TO: Attn: Human Resources West Bay Sanitary District 500 Laurel Street Menlo Park, CA Please note this position is subject to a pre-employment screening including a background investigation, medical evaluation and drug screening. Should you be a finalist and made a contingent offer of employment, you will be required to undergo these screenings prior to the District making a final employment decision. To apply, go to: to download the application packet. To pick up an application packet or submit your completed forms in person, the lobby hours of the Administration office are 8:00am 4:00pm, Monday Friday. Apply promptly as this recruitment will close at 4:00pm on 2/28/18 or remain open until filled. Incomplete applications will not be considered. Call the District at with any questions. Thank you. Enclosures W:\Admin Data\Personnel\Recruitment\Field Supervisor February 2018\1_Field Supervisor Applicant Cvr Memo.Doc SERVING AREAS IN MENLO PARK, ATHERTON, PORTOLA VALLEY, EAST PALO ALTO, REDWOOD CITY, WOODSIDE AND UNINCORPORATED SAN MATEO AND SANTA CLARA COUNTIES

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5 EMPLOYMENT APPLICATION West Bay Sanitary District 500 Laurel Street Menlo Park, California (650) Office (650) FAX PLEASE NOTE: Complete in blue or black ink. Applications that are not complete, not legible, or do not include information required shall not be considered. Completion of application is required even though a resume is submitted. Immigrations and Naturalization Service requirements must be met prior to hire. Keep the WBSD informed of changes of address. Position for which you are applying: Social Security Number: - - How did you hear about the job posting: _ Newspaper _ Friend Web Sites: _ CWEA _ CalOPPS _ WBSD _Other: If hired, can you provide evidence that you are legally authorized to work in the U.S. without immigration sponsorship by the District? Yes No PERSONAL HISTORY First Middle Initial Last Phone (8:00 am 5:00 pm) Address Number / Street City State Zip Code Address: EDUCATION Circle highest grade completed: High School Diploma received? Yes No If Yes, attach a copy of your High School Diploma or an official transcript with your application. List name and address of last High School attended: As applicable, a General Education Development (G.E.D.) or equivalent received? Yes No If Yes, attach a copy of your GED certificate or an official transcript with your application. Circle highest years of College or University completed: Degree? Yes No Grad Work? Yes No If Yes, attach a copy of your diploma(s) or an official transcript with your application. List College, University, Trade School, etc. below (attach supplemental sheet if necessary): and Address Years Completed No. of Units Earned Major License/Degree LICENSES List valid California Driver License: Number Class Expiration Date (If Out of State license, write in the State above. Attach supplemental sheet to explain.) Licenses, certificates, or other credentials (State, Professional, etc., which are required by this position): of license/certificate, number: Expiration Date: of license/certificate, number: Expiration Date: W:\Public Data\FORMS\AG-443 Employment Application_Updated Doc Page 1

6 EMPLOYMENT RECORD Begin with your present or most recent experience and account for ALL time during the past ten years. Leave no time unaccounted for. Attach supplemental sheets if necessary. May we contact your present employer? Yes No EMPLOYER NAME & ADDRESS: JOB TITLE & DUTIES: REASON FOR LEAVING: DATES OF EMPLOYMENT: Phone: Started Ended TYPE OF BUSINESS: Supervisor s : SALARY (if public agency) Started Ended EMPLOYER NAME & ADDRESS: JOB TITLE & DUTIES: REASON FOR LEAVING: DATES OF EMPLOYMENT: Phone: Started Ended TYPE OF BUSINESS: Supervisor s : SALARY (if public agency) Started Ended EMPLOYER NAME & ADDRESS: JOB TITLE & DUTIES: REASON FOR LEAVING: DATES OF EMPLOYMENT: Phone: Started Ended TYPE OF BUSINESS: Supervisor s : SALARY (if public agency) Started Ended EMPLOYER NAME & ADDRESS: JOB TITLE & DUTIES: REASON FOR LEAVING: DATES OF EMPLOYMENT: Phone: Started Ended TYPE OF BUSINESS: Supervisor s : SALARY (if public agency) Started Ended Use this space for comments on Experience: CERTIFICATION OF APPLICANT: (Read this statement carefully before signing.) I hereby certify that all statements made on or in connection with this application or any supplementary materials, including those regarding my training and experience are true and complete to the best of my knowledge and belief. I hereby authorize the West Bay Sanitary District to investigate the accuracy of this information and I release the West Bay Sanitary District from all claims and liabilities arising from such investigation. I understand and agree that any false statements, misrepresentations, or omissions of material fact on this application will be cause for refusal to hire or may cause termination of any employment with the West Bay Sanitary District. Date: Signature: W:\Public Data\FORMS\4_AG-443 Employment Application_Updated Doc Page 2

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9 Serving Our Community Since Laurel Street, Menlo Park, California (650) (650) FAX PHIL SCOTT District Manager EMPLOYMENT REFERENCES In reply, please refer to our File No. Applicant : Position Applying for: EMPLOYMENT REFERENCES Company Relationship to Applicant (e.g., Supervisor, co-worker, etc.) Phone Number Company Relationship to Applicant (e.g., Supervisor, co-worker, etc.) Phone Number Company Relationship to Applicant (e.g., Supervisor, co-worker, etc.) Phone Number PERSONAL REFERENCES Phone Number Phone Number SERVING AREAS IN MENLO PARK, ATHERTON, PORTOLA VALLEY, EAST PALO ALTO, REDWOOD CITY, WOODSIDE AND UNINCORPORATED SAN MATEO AND SANTA CLARA COUNTIES W:/Admin Data /Personnel/Recruitment/Field Supervisor 2018/6_Field Supervisor Employ Refs.doc

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