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CBWCD Statement

We Are An Equal Opportunity Employer
We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related mental or physical disability, or any other legally protected status.
Click here to view Job Description Conservation Landscape Worker I (CLWI)
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Click here to view Job Description Landscape Maintenance Worker I (LMWI)
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Personal Information

Education

Employment Experience

Start with your present or last job. Include military service assignments and volunteer activities which relate to the job for which you are applying. You may exclude organizations which indicate race, color, religion, gender, national origin, mental or physical disability or other protected status.
Employer
Dates Employed
Address
Phone Number
Job Title
Supervisor
Work Performed
Employer
Dates Employed
Address
Phone Number
Job Title
Supervisor
Work Performed
Employer
Dates Employed
Address
Phone Number
Job Title
Supervisor
Work Performed
Employer
Dates Employed
Address
Phone Number
Job Title
Supervisor
Work Performed
Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
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References

Give name, address, and telephone number of three business references who are not related to you.
Full Name*
Relationship*
Company*
Phone Number*
Reference email address*
Full Name*
Relationship*
Company*
Phone Number*
Reference email address*
Full Name*
Relationship*
Company*
Phone Number*
Reference email address*
Have you ever had any training in the United States military which is related to the job for which you are applying?*
1. Yes
1. No
If yes, please describe:
Do you have the physical and mental ability to perform the tasks on the attached job description, with or without accommodation?*
1. Yes
1. No
If accommodation is necessary, please describe below.
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Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge.*
1. Check to initial
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand and acknowledge that the policy of the CBWCD is such that the existence of a criminal conviction will not necessarily disqualify my application for employment. I understand that if offered employment, the offer may be contingent on passing a pre-employment alcohol and drug screen and a pre-employment physical. I voluntarily agree to submit to these procedures. I also understand that I will be required to submit proof of my identity and legal right to work in the United States on my first day of employment. This employer participates in E-Verify and will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee's Form I-9 to confirm work authorization.*
1. Check to initial
If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid California driver's license and understand that I will be required to provide a copy of my official driving record and proof of insurance.*
1. Check to initial
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the CBWCD.*
1. Check to initial
Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the CBWCD, I am entitled to copies of any such records obtained, unless I mark the checked box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.*
1. Check to initial
I waive receipt of a copy of any public record described in the paragraph above.
1. Check if desired
Applicant Signature*
Date*
Date
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Record Inquiry Waiver

To Whom It May Concern:
Having made an application for employment with the Chino Basin Water Conservation District (CBWCD), and desiring it to be informed as to my previous record and character, I hereby authorize any authorized representative of CBWCD, bearing this release, or a copy of it, within one year of its date, to obtain any information in your files pertaining to my employment, attendance, athletic, personal history, performance report, disciplinary records, including materials which may have been sealed and understood to be withheld pursuant to any prior agreement or court proceeding involving disciplinary matters, and credit records.

I hereby direct you to release this information upon request of the bearer. This release is executed with the full knowledge and understanding that the information is to be used only for the official use of CBWCD.

I hereby release you, as the custodian of such records, your employer, its officers, employees, or related personnel both individually and collectively, from any and all liability for damage of any kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release information, or any attempt to comply with it. Should there be any questions as to the validity of this release, you may contact me as indicated below.

I understand that I have the right to receive a copy of this authorization and acknowledge that I have received a copy of it.
Full Name*
Date*
Date
Address1*
Address2
City*
State*
Zip*
Chino Basin Water Conservation District
4594 San Bernardino St
Montclair, CA 91763
909-626-2711

Leave This Blank:

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

This field is not part of the form submission.
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Conservation Landscape Worker I and/or Landscape Maintenance Worker I

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CBWCD Statement

Personal Information

Education

Employment Experience

References

Applicant's Statement

Record Inquiry Waiver

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HOURS OF OPERATION