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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:
Middle Name:
Last Name:
How did you learn about us? Advertisement
Relative
Inquiry
Employment Agency
Friend
Other
Address
City/State/Zip
Telephone 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 relatives work here? Yes No
If so, whom and what is the relationship?
Do any of your friends work here? Yes No
If so, whom?
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
Starting 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
Starting 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
Starting 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
Starting 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

Would you like to complete the Equal Employment Opportunity Voluntary Self-Identification Form?
Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by Human Resources Department.
Yes       No
     
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