Information message *Required Fields Except as explicitly provided, employees of the Pittsburgh Water and Sewer Authority must be residents of the City of Pittsburgh at the time of hiring and must maintain residency through the term of employment. *Date *Application for Position Of: Personal Information *Name *First Name Middle Initial *Last Name *Present Address *Present Address Present Address Line 2 *City/Town *State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming *ZIP/Postal Code *Phone Number: Day *Phone Number: Evening *Email Address Referred By: *Are you currently employed by any other Authority or governmental agency? Yes No If yes, where? List names of all your relatives who are working for the PWSA or any other City agency. Name Relationship Agency Operations Name Relationship Agency Name Relationship Agency Name Relationship Agency *Are your employment, education, or military records under another name? Yes No If yes, give name: *First Name Middle Initial *Last Name *Did you serve in the Armed Forces of the United States? Yes No If yes: Serial Number Entrance Date Separation Date Branch Type of Discharge *Do you have a disability which may require assistance/accommodation during the selection process? Yes No If yes, what assistance or accommodation is required? Education and Training High School High School Name, City, and State High School Name City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Number of Years Attended Did you graduate? Yes No Major Subjects, Special Courses, Degrees College or University College or University Name, City, and State College or University Name City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Number of Years Attended Did you graduate? Yes No Major Subjects, Special Courses, Degrees College or University College or University Name, City, and State College or University Name City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Number of Years Attended Did you graduate? Yes No Major Subjects, Special Courses, Degrees Graduate School Graduate School Name, City, and State Graduate School Name City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Number of Years Attended Did you graduate? Yes No Major Subjects, Special Courses, Degrees Other Education Other School Name, City, and State Other School Name City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Number of Years Attended Did you graduate? Yes No Major Subjects, Special Courses, Degrees Licenses and Certifications Other Skills *Periods of Employment Describe your work experience in detail beginning with your current or most recent job. Include military service (indicate rank) and job-related volunteer work. If applicable, indicate the number of employees supervised. All information in each block must be completed. Use the plus sign button in the right column to add separate blocks to describe each position or gap in employment. Resumes may be attached to provide additional information. *Periods of Employment *Name of Present or Last Employer *Address *Phone Number *Your Job Title *Supervisor *Start Date *End Date *Hours per Week *Duties and Responsibilities *Reason for Leaving Resume Upload your resume here: One file only.100 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Cover Letter Upload your cover letter here: One file only.100 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. *How did you learn about this position? Employee Bulletin Board Employee Referral Newspaper Ad Internet Other… Enter other… *I understand that all applicants are subject to a background check and pre-employment drug test prior to appointment. *Initial Here Initial Above *I understand that routine physical exams may be required for certain positions covered by bargaining unit agreement. *Initial Here Initial Above I hereby swear (or affirm) that this application and personal data forms contain no misrepresentation or falsifications, omissions or concealment of material fact, and that the information given by me is true and complete to the best of my knowledge. I am aware that all statements made by me on this application are subject to later investigation. I am aware that should such investigation at any time disclose any such misrepresentation, falsification, omission, or concealment of material fact, my application may be rejected and if already employed, I may be dismissed from my position, and I am subject to prosecution.I authorize the Pittsburgh Water and Sewer Authority to investigate and verify any information contained in my application for employment including, but not limited to prior work and education records, criminal history, medical information, etc.I further authorize any past or present employer, any law enforcement agency, any physician or hospital or any school to release any and all information about me contained in their records to the Pittsburgh Water and Sewer Authority.I hereby release any past or present employer, any law-enforcement agency, any physician or hospital or any school, and any and all of their employees from any liability in furnishing such information to the Pittsburgh Water and Sewer Authority. *Applicant’s Signature Sign above *Signature Date CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
