APPLICATION FOR EMPLOYMENT

Transcription

1 ARKANSAS VALLEY ELECTRIC COOPERATIVE CORPORATION 1811 WEST COMMERCIAL STREET PO BOX 47 OZARK ARKANSAS (479) An Equal Opportunity Employer APPLICATION FOR EMPLOYMENT DATE: This application will be considered only for the vacant position for which you are applying. To be considered for other vacant positions, a new application must be filed. The following information is requested in order to help us make the best possible placement within the Cooperative. All portions of this application pertaining to you must be completed. We appreciate the time you spend in filling in this application form. PLEASE PRINT Name: (Last) (First) (Middle) Address: Telephone No. Are you at least eighteen years of age? [ ] Yes Do you have a legal right to work in the United States? [ ] Yes Are you a relative, either by blood or marriage, of any employee or Director of the Cooperative? [ ] Yes Have you ever applied for a job with the Cooperative? [ ] Yes If yes, when? Have you ever worked at the Cooperative before? [ ] Yes If yes, when? Position applied for and salary desired (be specific): $ per Are you able to perform the essential functions of the position with or without accommodation?? [ ] Yes If you are selected for employment, on what date can you start work? Are you available to work from 8 AM to 5 PM, Monday through Friday? [ ] Yes Will you work overtime if asked? [ ] Yes Have you ever been in the Armed Forces? [ ] Yes Are you now a member of the National Guard? [ ] Yes Specialty Date Entered Discharge Date 1 Revised: Feb. 2012

2 In what state or states do you possess a valid and current driver s license? State: License No.: State: License No.: State: License No.: State: License No.: Note: Applicants applying for positions that require them to drive Cooperative vehicles must also fill out the Driver s Application. EMPLOYMENT RECORD (Most recent employer first) Dates Name and Address of Employer Job Title and Brief Description of Duties Salary Exact Reason for Leaving Attach additional sheets if necessary. EDUCATION: Name Years Completed Study Graduate or Degree High School College Business/Technical Have you ever been convicted of a felony? [ ] Yes If yes, explain number of conviction(s), nature to offense(s) leading to conviction(s), how recently such offense (s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. 2 Revised: Feb. 2012

3 CLERICAL AND SECRETARIAL APPLICANTS ONLY Place one check for knowledge. Place two checks for experience. 10-Key Internet Network Software A/R and/or A/P Load Management Payroll System Microsoft Windows PBX System Customer Service Personal Computer Data Entry Proofreading Fax Machine Typing wpm TRADES, CRAFTS. AND TECHNICAL APPLICANTS ONLY Place one check for knowledge. Place two checks for experience. Warehousing Computer inventory methods Lay out work orders Prepare work orders Basic electricity Tree trimming Brush clearing Clearing machinery Material control Perpetual inventory Automotive maintenance Painting and bodywork on vehicles Electric and gas welding Hotline work, primary and secondary Regulators, capacitors, breakers and switches Electrical hand tools Electrical safety Radio communication and operation Pole inspection Load management systems Meter reading Collecting consumer accounts Handling consumer concerns Connecting and disconnecting meters Electrical mapping systems Load switching Substation construction Line construction Transformer banks Underground experience, (primary and/or secondary) Please attach any special training, skills, certifications, licenses or other languages related to the position of which you are applying. PERSONAL REFERENCE (Not former Employers or Relatives) Name Position Company Address Telephone Name Position Company Address Telephone An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional necessary to describe your full qualifications for the specific position for which you are applying. 3 Revised: Feb. 2012

4 Applicant Must Read and Sign CERTIFICATION I CERTIFY THAT ALL INFORMATION PROVIDED IN SUPPORT OF MY EMPLOYMENT WITH THE COOPERATIVE, INCLUDING BUT NOT LIMITED TO THIS APPLICATION, RESUMES, MEDICAL INFORMATION, AND INFORMATION PROVIDED BY ME DURING INTERVIEWS, IS CORRECT TO THE BEST OF MY KNOWLEDGE, AND I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF RELEVANT FACTS IN SEEKING EMPLOYMENT WILL RESULT IN MY DISQUALIFICATION FROM FURTHER CONSIDERATION OR MY DISMISSAL FROM EMPLOYMENT. I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COOPERATIVE, AND I UNDERSTAND THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT THE OPTION OF THE COOPERATIVE OR MYSELF, I FURTHER UNDERSTAND THAT NO PERSON IS AUTHORIZED TO MAKE ANY REPRESENTATION CONTRARY TO THE ABOVE STATEMENT UNLESS SUCH REPRESENTATION IS APPROVED BY THE BOARD OF DIRECTORS AND IS EMBODIED IN A WRITTEN AGREEMENT SIGNED BY THE PRESIDENT OR THE CHIEF EXECUTIVE OFFICER OF THE COOPERATIVE. I FURTHER UNDERSTAND THAT IF OFFERED EMPLOYMENT, I WILL BE REQUIRED TO TAKE A PHYSICAL EXAMINATION AND THAT SUCH EXAMINATION WILL INCLUDE BLOOD, BREATH, URINE, OR SALIVA TESTS TO DETERMINE THE PRESENCE OR USE OF ALCOHOL OR ILLEGAL CONTROLLED SUBSTANCES. Signature of Applicant Date 4 Revised: Feb. 2012

5 Self-Identification Section Completion is Voluntary Arkansas Valley Electric Cooperative Corporation is an equal opportunity employer. It is the Cooperative's policy to provide equal opportunity to all qualified persons, regardless of race, color, age, sex, religion, national origin, veteran status or handicap. This form is used to collect information so that we may analyze and monitor our equal opportunity efforts and to complete aggregate statistical reports required by the federal government. This form is removed from the application prior to the hiring supervisor's review for the application, and is maintained separately from application and personnel files. Providing or failing to provide this information does not adversely affect any consideration you may receive for employment or later advancement in employment. Please Check the Appropriate for Each Category: RACE/ETHNICITY [ ] Black (not of Hispanic origin) - All persons having origins in any of the black racial groups of Africa. [ ] Hispanic - All persons of Mexican, Puerto Rican, Cuban, Central or South America or other Spanish culture or origin regardless of race. [ ] Asian or Pacific Islander - All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands. This area includes, for example, China, Japan, Korea, and the Philippine Islands and Sanoa. [ ] White (not of Hispanic origin) - All persons having origins in any of the original Europe, North Africa of the Middle East. [ ] American Indian or Alaskan Native - All persons having origins in any of the original peoples of North America and who maintain cultural identification through tribal affiliation or community recognition. Please identify with which tribe you are affiliated. [ ] Male [ ] Female SEX VETERAN [ ] Disabled Veteran - Person entitled to disability compensation under law administered by Veterans Administration for disability rated 30% or more OR person discharge/released from active duty for disability incurred or aggravated in the line of duty. [ ] Vietnam Era Veteran - Person who served on active duty for more than 180 days, any part of which occurred between August 5, 1964 to May 7, 1975 and was discharged/released with other than a dishonorable discharge OR was discharged/released from active duty for a service-connected disability if such active duty occurred during previously mentioned dates. [ ] Veteran REFERRAL SOURCE: How did you find out about this job? [ ] State Employment Office [ ] Newspaper Ad [ ] Friend/Relative [ ] Cooperative Employee [ ] Other [ ] Self Referral: Walk-in, Write-in, Phone-in 5 Revised: Feb. 2012