Employment Application

Section 1 of 5

General Information

Position Applied For:

Name

First Middle Last

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone

Cell Phone

Are you under the age of 18?

Yes
No

Do you have a valid driver's license?

**A valid driver's license is a job-related requirement of some positions at Adams-Columbia Electric Cooperative.

Yes
No

Are you related by blood or marriage to anyone now employed by Adams-Columbia Electric Cooperative or a member of the Adams-Columbia Electric Cooperative Board of Directors?

Yes
No

If the answer is "yes", state the name(s), relationship(s), and position(s) held by the person(s) to whom you are related.

Are you a U.S. citizen? You will be required as a part of the application process to provide any employment eligibility verification mandated by the federal government.

Yes
No

Have you ever been employed by Adams-Columbia? If yes, provide dates of employment.

Yes
No

Employment History

Provide the employment information requested below. Begin with your present or most recent employment. Use the "Other Information" section to complete your employment history (if necessary).

Employer Name:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number:

Type of Business:

Name of Supervisor(s):

Job Title Held:

Describe the work you did:

Employment Duration:

Reason for leaving;

Employer Name:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number:

Type of Business:

Name of Supervisor(s):

Job Title Held:

Describe the work you did:

Employment Duration:

Reason for leaving:

Employer Name:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number:

Type of Business:

Name of Supervisor(s)

Job Title Held:

Describe the work you did:

Employment Duration:

Reason for leaving:

May we contact the employers listed above?

Yes
No

If no, indicate which employer(s) we should not contact:

Education and Training

Indicate all schools that you have attended.

High School:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Did you graduate?

Yes
No

Major Course(s) of Study:

Vocational/Technical:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Did you graduate?

Yes
No

Diploma/Degree and Year Graduated:

Major Course(s) of Study:

College/University:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Did you graduate?

Yes
No

Diploma/Degree and Year Graduated:

Major Course(s) of Study:

Graduate School:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Did you graduate?

Yes
No

Diploma/Degree and Year Graduated:

Major Course(s) of Study:

Other Post High School Courses Completed:

Specialized Training or Skills:

**List current typing and/or shorthand speed, personal computer training, computer literacy, welding certification, special licenses, etc., that you possess that pertain for which are you applying.

Service in the Armed Forces

Branch of Armed Forces:

Rank:

General Duties/Training:

Other Information

Please upload any additional documents here:

Drop files here or

Max. file size: 6 MB.

Please list any additional information here:

Read Carefully Before Submitting*

I certify that the facts contained in this application for employment at Adams-Columbia Electric Cooperative are true and complete to the best of my knowledge. I understand that any misrepresentations, falsifications, or deliberate omissions may result in my immediate dismissal. I authorize investigation of all statements herein. I understand that as part of being considered for employment by Adams-Columbia Electric Cooperative I will be required to undergo a physical examination which will include blood and/or urine testing for drugs. I also authorize by electronically submitting this application, the organizations and individuals referred to herein to furnish information to the Cooperative. The Cooperative shall be held harmless should it, in processing this employment application, rely on information provided by these sources, even if the information provided is inaccurate or erroneous. Additionally, I understand that nothing contained in this employment application or in the granting of an interview or in any policies, procedures, or handbooks that I might receive, is intended to create an employment contract between Adams-Columbia Electric Cooperative and myself. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Cooperative. If an employment relationship is established, I understand that I have a right to terminate my employment at any time for any reason or for no reason, and Adams-Columbia Electric Cooperative retains a similar right regarding the discontinuation of my employment subject only to the terms of a collective bargaining agreement, if one applies, and to the full extent permitted by law.

I authorize to submit my application electronically

Name*

First Last

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Phone

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Please read before completing the Employment Application

Section 1 of 5

Employment History

Education and Training

Service in the Armed Forces

Other Information