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APPLICATION FOR EMPLOYMENT

 

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

All qualified applicants will receive consideration for employment without regard to race, color,

religion, sex, sexual orientation, gender identity, age, national origin, disability or veteran status.

 

(PLEASE PRINT)

Date of Application:       ___________________________________

Position Applying For:   _____________________________________________________________________________________________

Did you receive a copy of the job description for the position you are applying for?              o Yes       o No

Name (Last, First, Middle): ___________________________________________________________________________________________

Address (Number, Street, City State and Zip Code):                                                                                     __________________________________________________________________________________________

_____________________________________________________________________________________________

Telephone Number(s): _____________________________________________________________________________________

Do you have the legal right to work in the United States?                                                                        o Yes       o No

(Proof of citizenship or immigration status will be required upon employment.)

How were you referred to us?  ______________________________________________________________________________

Have you ever filed an application with us before?                                                                        o Yes       o No

If yes, when?   ____________________________________

Have you ever been employed with us before?                                                                               o Yes       o No

If yes, when?   ____________________________________

Are you at least 18 years of age?                                                                                                        o Yes       o No

In what state or states do you possess a valid current  driver’slicense? _________________________________________________             

In what state or states have you ever possessed a driver’s license?  _____________________________________________________

Can you perform the essential functions of the job for which you are applying?                      o Yes       o No

(See attached job description for a list of essential functions of the job for which you are applying.)

Are you currently employed?                                                                                                                o Yes       o No

If yes, may we contact your present employer?                                                                                    o Yes       o No

On what date would you be available for work?  __________________________

PERSONAL REFERENCES

Give name, occupation, address and telephone number of three references who are not related to you and are not previous employers.

  1. _____________________________________________________________________________________________________________________________
  2. _____________________________________________________________________________________________________________________________
  3. _____________________________________________________________________________________________________________________________

Apart from absence for religious observation, are you available to work from 8:00 a.m.

to 5:00 p.m. Monday through Friday?                                                                                               o Yes       o No

If no, what hours can you work?  _________________________________________

Will you work overtime if asked?                                                                                                      o Yes       o No

Are you willing to work after hours call-out duty and on-call assignments?                              o Yes       o No

Have you ever been convicted of a felony?                                                                                     o Yes       o No

(Convictions will not necessarily disqualify an applicant from employment.)

If yes, give details: _________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

Have you ever been convicted of a power (electricity) theft or power diversion?                    o Yes       o No

If yes, give details: _________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

EDUCATION

 

High

School

Undergraduate

College/University

Graduate

Professional

School Name and Location

     

Years Completed

1     2     3     4

1     2     3     4

1     2     3     4

Diploma, Degree or Major

     

(On the next three items, please exclude those that may disclose your race, creed, color, religion, sex, national origin, ancestry, age, disability, veteran status, union affiliation, or any other protected category.)

Describe any specialized training, apprenticeship, skills and extra-curricular activities. ______________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________                                                                                                                         

Describe any honors you have received. _________________________________________________________________________________  _____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

State any additional information you feel may be helpful to us in considering your application. _______________________

__________________________________________________________________________________________________________________________

EMPLOYMENT EXPERIENCE

Start with your present job or last job.  Include any job-related military service assignments and volunteer activities.

(You may exclude organizations that indicate race, color, religion, national origin, age, ancestry, or handicap or other protected status.)

(1)

Employer:                       __________________________________________________________________________________

Address:                       __________________________________________________________________________________

Telephone Number(s):                                         _________________________________________________________________________

Dates Employed:                                                                           Hourly Rate/Salary:

From __________________ To _________________         Starting ________________ Final _______________

Job Title:      ________________________________           Supervisor:                       ________________________________

Work Performed:                                  _____________________________________________________________________________

_____________________________________________________________________________________________

Reason for Leaving:                                      ___________________________________________________________________________

(2)

Employer:                       __________________________________________________________________________________

Address:                       __________________________________________________________________________________

Telephone Number(s):                                         _________________________________________________________________________

Dates Employed:                                                                           Hourly Rate/Salary:

From __________________ To _________________         Starting ________________ Final _______________

Job Title:      ________________________________           Supervisor:                       ________________________________

Work Performed:                                  _____________________________________________________________________________

_____________________________________________________________________________________________

Reason for Leaving:                                      ___________________________________________________________________________

(3)

Employer:                       __________________________________________________________________________________

Address:                       __________________________________________________________________________________

Telephone Number(s):                                         _________________________________________________________________________

Dates Employed:                                                                           Hourly Rate/Salary:

From __________________ To _________________         Starting ________________ Final _______________

Job Title:      ________________________________           Supervisor:                       ________________________________

Work Performed:                                  _____________________________________________________________________________

_____________________________________________________________________________________________

Reason for Leaving:                                      ___________________________________________________________________________

(4)

Employer:                       __________________________________________________________________________________

Address:                       __________________________________________________________________________________

Telephone Number(s):                                         _________________________________________________________________________

Dates Employed:                                                                           Hourly Rate/Salary:

From __________________ To _________________         Starting ________________ Final _______________

Job Title:      ________________________________           Supervisor:                       ________________________________

Work Performed:                                  _____________________________________________________________________________

_____________________________________________________________________________________________

Reason for Leaving:                                      ___________________________________________________________________________

If you need additional space, please continue on a separate sheet of paper.

Special Skills and Qualifications.  Summarize special job-related skills and qualifications acquired from employment or other experience, which would be or are related to the position you are applying for,

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

APPLICANT’S STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days.  Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT, UNLESS OTHERWISE DEFINED BY APPLICABLE LAW, ANY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION IS OF AN “AT WILL” NATURE, WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER MAY DISCHARGE AT ANY TIME WITH OR WITHOUT CAUSE.  IT IS FURTHER UNDERSTOOD THAT THIS “AT WILL” EMPLOYMENT RELATIONSHIP MAY NOT BE CHANGED BY ANY WRITTEN DOCUMENT OR BY CONDUCT UNLESS SUCH CHANGE IS SPECIFICALLY ACKNOWLEDGED IN WRITING BY AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION.

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 employer.

_______________________________________________________                                                                                                                        ____________________________________

Signature of Applicant                                                                                Date

Voluntary Self-Identification of Race, Ethnicity and Gender

Southeastern Electric Cooperative, Inc. (hereinafter “the Cooperative”) is subject to certain federal government recordkeeping and reporting requirements for the administration of civil rights laws and regulations.  In order to comply with these laws, the Cooperative invites applicants/employees to voluntarily self-identify their race, ethnicity and gender.  Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment.  The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported annually to the federal government for civil rights enforcement.  When reported, data will not identify any specific individual.

ETHNICITY

¨    Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

RACE

¨    American Indian or Alaskan Native (not Hispanic or Latino) - A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment.

¨    Asian (not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

¨    Black or African American (not Hispanic or Latino) - A person having origins in any of the Black racial groups of Africa.

¨    Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

¨    White (not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

¨    Two or More Races (not Hispanic or Latino) - All persons who identify with more than one of the above five races.

GENDER

¨    Male

¨    Female

 

 

 

Applicant’s/Employee’s Name: ___________________________________________            Date: ________________

 

 

Note: If an employee declines to self-identify, employment records or observer identification may be used.