Withlacoochee River Electric Cooperative, Inc.

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

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

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.

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