Employment Application


If you prefer to download the application click here

Please fill out the employment application in its entirety. 

Applicant Information

Full Name:


Professional / Technical Licenses or Certificates
Previous Employment

Please list the past 10 years of your employment history starting with your present or most recent job. If you need more space, you may attach additional sheets.


Please have three (3) professional references with their contact information available upon request.

Military Service
Equal Opportunity Employer

Leucadia Wastewater District (LWD) considers applicants for all positions without regard to race, color, religion, sex, national origin, age, sexual orientations, ancestry, martial or veteran status, mental or physical disability, or any other legally protected status. Qualified disabled applicants with special needs who desire assistance in completing the application process must notify LWD in advance, and, whenever possible, a reasonable accommodation will be made in accordance with current regulations.

Please Read Very Carefully

I certify that all the information contained within this application (and any and all attachments) is true and correct to the best of my knowledge, and I understand that any false information or omissions may lead to the rejection of my application or, if I am employed, discipline up to and including termination at the time any such false information or omission is discovered. I authorize investigation of all statements contained within this application; authorize LWD to secure information about my background and experience with former employers, educational institutions, and any relevant agencies; and authorize those parties to provide information to LWD concerning my background and experience. I understand that offers of employment are contingent upon successful completion of an LWD-paid physical examination to see if the undersigned applicant is fit to perform the essential functions of the job. All job applicants who are selected to fill a position must, as part of that physical examination, submit to and pass a drug-screening test. Some job classifications require a respirator fitness evaluation. I understand that employment with the LWD is for an indefinite and unspecified duration and that employment with the LWD is at the mutual consent of the employee and the LWD and can be terminated at will, at any time, by the employee or the LWD per LWD’s Human Resources Policy Manual. I agree that the Leucadia Wastewater District and my previous employers shall not be held liable in any respect if any employment offer is not tendered, is withdrawn or my employment is terminated due to falsity of the statements and answers in this application form or during my interview(s).


Required Supplemental Questions

Responses to these supplemental questions must be completed and submitted together with the required LWD Application form. Clarity, conciseness and completeness of answers are factors considered in the selection process. If additional space is needed, please attach page(s) after this page.