District Use Only

EMPLOYMENT APPLICATION
IVGID Human Resources An Equal Opportunity Employer Date:
893 Southwood Boulevard Appl #:
Incline Village, NV 89451
(775) 832-1100/(775) 832-1359 fax
[email protected]

If you have a disability and believe you require accommodation for the disability during the selection
process, please contact us to make appropriate arrangements.

Name:
First Middle Initial Last

Mailing Address:
City, State, Zip - Country

Phone: ( ) Alt Phone: ( )

Email Address:

Have you ever been employed by IVGID? Yes No

If Yes, what department? Date(s) Employed:

List any relatives currently employed by IVGID:

Position(s) Applied For:

1) 2) 3)

Position Status: Full-Time Part-Time Seasonal On-Call Temporary

Please note any days or hours you cannot or prefer not to work:_____________ Date available:________

Do you understand the requirements of the job(s) for which you have applied? Yes No

Can you perform the requirements of the job(s) with or without reasonable accommodations? Yes No

Certain positions require that applicants meet age requirements: Are you at least 18 years of age?
Yes No

How did you hear about us?

Newspaper Please specify: Friend/Acquaintance
Employee Please specify: Previous Employee
Internet Please specify: Job Fair
Other Please specify: Please specify:

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EDUCATION RECORD
Did you graduate from high school or receive a GED certificate? Yes No

School Name Credits Diploma, Degree

Location Major / Field of Study
College/Technical/Vocational/Other Earned or Certificate

For positions that require a high school diploma or GED or a college degree, a copy of the high school diploma/GED
certificate or college diploma may be required.

CERTIFICATION AND LICENSES

List driver's license and other current licenses, certifications or registrations required for the position(s) for
which you are applying.

Type Date Issued Date Expires Entity

SKILLS
List any special skills you possess and/or equipment or office machines you can operate (Example:
bartending, cashiering, electrical, accounting, management/supervisory, skiing, golfing, etc).

Foreign Language Read Proficiency

Write Speak
Computer Skills Proficiency

Additional Skills Proficiency

OTHER INFORMATION
Have you ever been disciplined in your employment related to workplace violence? Yes No
If yes, please explain:

Do you presently use illegal drugs? Yes No

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EMPLOYMENT HISTORY
List employers, starting with the most recent (including all paid military and volunteer work), for the past
10 years. Use a separate block for each position. DO NOT use references such as "See Resume" in
place of completing this section.

May we contact all employers listed? Yes No (Attach a list of any exceptions with an explanation.)

Employer: Position/Job Title:

Address:
Related Duties:

Reason for leaving:

Employer: Position/Job Title:

Address:
Related Duties:

Reason for leaving:

Employer: Position/Job Title:

Address:
Related Duties:

Reason for leaving:

Employer: Position/Job Title:

Address:
Related Duties:

Reason for leaving:

Employer: Position/Job Title:

Address:
Related Duties:

Reason for leaving:

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ADDITIONAL INFORMATION
Please state below any other information that would be helpful in determining your qualifications for this
position. You may include significant accomplishments, previous career highlights, or any other
information that is not included in this employment application.

REFERENCES
Please list references that are job related (i.e. co-workers), not related to you.
Name Relationship / Occupation Telephone Years Known

ACKNOWLEDGMENTS
Please READ ALL of the following statements and INITIAL EACH of the boxes to indicate you have read and
understand each of the statements. If you have questions, contact Human Resources.
Following an offer of employment, I will submit verification of my legal right to work in the United States.
All offers of employment and all information regarding compensation and other terms and conditions of
employment may be made in writing for specific positions.
Employment will be at-will unless specifically stated to be otherwise. At-will means IVGID may terminate
my employment at any time with no advance notice and for any reason or no reason.
This application is the property of IVGID, and will become part of my personnel file if I am hired.

PLEASE READ CAREFULLY

I authorize the Incline Village General Improvement District (IVGID) to contact any employer or individual that I have listed on my
employment application, resume and or mentioned in job interviews, to obtain from them any relevant information regarding my
previous employment, military service, criminal history, characteristics or traits, or other qualifications for employment and/or
continued employment with IVGID. I further authorize IVGID to contact any entity for job-related information regarding education,
licenses, and/or certificates which I may currently hold or may have held in the past.

In exchange for IVGID’s consideration of my employment application, and/or my continued employment with IVGID, if any, I
authorize anyone possessing this information to furnish it to IVGID upon request, and I release the individual company or institution
and all individuals providing the information or acquiring the information, including IVGID, from all claims, liability, and damages
whatsoever in furnishing, obtaining, or using said information including, but not limited to, claims for defamation, libel, slander,
infliction of emotional distress, and interference with current or prospective economic relations.

I further understand this consent will apply during the course of my employment with IVGID, should I obtain such employment. I
understand and agree this consent shall remain in effect indefinitely.

Additionally, my signature below certifies that the information provided is true and correct to the best of my knowledge. 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 I am required to abide by all rules and regulations of IVGID.

Signature of Applicant: Date:

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