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    Every Family Needs A Plan - Prepare NOW for Hurricane Season!
    JOB APPLICATION FORM
    Withlacoochee River Electric Coop., Inc., is a Drug Free Workplace pursuant to Florida Statutes, Chapters 316 and 440.

    Please complete the form below and click submit. All fields marked with an * are required.
    First Name Last Name
    Middle Name
    How did you learn about us? Advertisement Relative Inquiry
    Employment Agency Friend Other
    Address
    City/State/Zip
    Telephone Number
    Social Security Number
    Best time to contact you at home
    If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No
    Have you ever filed an application with us before? Yes No
    If Yes, give date
    Have you ever been employed with us before? Yes No
    If Yes, give date
    Do any of your friends or relatives, other than spouse, work here? Yes No
    Are you currently employed? Yes No
    May we contact your present employer? Yes No
    Do you have a CDL license? Yes No
    Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status
    Proof of citizenship or immigration status will be required upon employment     		Yes No
    Date available for work / / mm/dd/yyyy
    What is your desired salary range?
    Are you available to work Full-Time (please indicate 1 2 3 shift)
    Part-Time (please indicate Mornings Afternoon Evenings )
    Temporary (date available / / mm/dd/yyyy)
    Are you currently on "lay-off" status and subject to recall? Yes No
    Can you travel if a job requires it? Yes No
    Education
    High School
    Name and Address
    Course of Study
    Years Completed
    Diploma Degree
    Undergraduate College
    Name and Address
    Course of Study
    Years Completed
    Diploma Degree
    Graduate Professional
    Name and Address
    Course of Study
    Years Completed
    Diploma Degree
    Other (Specify)
    Name and Address
    Course of Study
    Years Completed
    Diploma Degree
    Describe and specialized training, apprenticeship, skills and extra-curricular activities.
    Describe any job-related training in the United States military.
    Employment Experience
    1.
    Employer
    Address
    Telephone Number
    Job Title
    Supervisor
    Reason for Leaving
    Date Employed From / / mm/dd/yyyy
    Date Employed To / / mm/dd/yyyy
    Staring Hourly Rate/Salary
    Final Hourly Rate/Salary
    Work Performed 500 Character Limit
    2.
    Employer
    Address
    Telephone Number
    Job Title
    Supervisor
    Reason for Leaving
    Date Employed From / / mm/dd/yyyy
    Date Employed To / / mm/dd/yyyy
    Staring Hourly Rate/Salary
    Final Hourly Rate/Salary
    Work Performed 500 Character Limit
    3.
    Employer
    Address
    Telephone Number
    Job Title
    Supervisor
    Reason for Leaving
    Date Employed From / / mm/dd/yyyy
    Date Employed To / / mm/dd/yyyy
    Staring Hourly Rate/Salary
    Final Hourly Rate/Salary
    Work Performed 500 Character Limit
    4.
    Employer
    Address
    Telephone Number
    Job Title
    Supervisor
    Reason for Leaving
    Date Employed From / / mm/dd/yyyy
    Date Employed To / / mm/dd/yyyy
    Staring Hourly Rate/Salary
    Final Hourly Rate/Salary
    Work Performed 500 Character Limit
    List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:
    Additional Information
    Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience.
    Specialized Skills
    (Check Skils/Equipment Operated)     		Terminal PC/MAC Typewriter WPM
    SpreadSheet Word Processing Shorthand Internet
    Product/Mobile Machinery (list)
    Other (list)
    State any additional information you feel may be helpful to us considering your application.
    Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

    Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the actyivities involved in such a job or occupation has been given.     Yes No
    References
    1.
    Name
    Address
    Phone Number
    2.
    Name
    Address
    Phone Number
    3.
    Name
    Address
    Phone Number
    I certify that answer given herein are true and complete.

    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 Employee 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.

    I AGREE
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