Employment Application

Name (First, Middle, Last) *

Position Applied For *

Phone Number *

Phone Number Type

Home

Mobile

Work

E-Mail Address *

Mailing Address *

Are you under the age of 18? *

Yes

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

Are you legally eligible for employment in the United States? *

Yes

Have you ever been employed by Price Electric Cooperative? *

Yes

If yes, provide dates of employment.

Were you referred by a current Price Electric Cooperative employee for this position? *

Yes

If yes, provide the employee's name.

Desired Salary Range *

Employment Hisory

Provide the employment information requested below. Begin with your present or most recent employment.

Most Recent Job

Job Title

Employer Name & Address

Employer Phone Number

Supervisor Name & Phone Number

Type of Business

Dates of Employment

Describe the work you did:

Reason for Leaving

Employer #2

Job Title

Employer Name & Address

Employer Phone Number

Supervisor Name & Phone Number

Type of Business

Dates of Employment

Describe the work you did:

Reason for Leaving

May we contact the employers listed?

Yes

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

Education and Training

Indicate all schools that you have attended.

High School Name & Address *

Indicate Last Year Completed

Vocational/Technical School

Vocational/Technical School Name & Address

Major Course(s) of Study

Diploma/Degree & Year Graduated-Vocational/Technical School

Vocational/Technical Last Year Completed

College/University

College/University Name & Address

Major Course(s) of Study-College/University

Diploma/Degree & Year Graduated-College/University

College/University Last Year Completed

Graduate School

Graduate School Name & Address

Major Course(s) of Study-Graduate School

Diploma/Degree & Year Graduated-Graduate School

Graduate School Last Year Completed

Service in the Armed Forces

Branch of Armed Forces

General Duties/Training

Specialized Training or Skills

Please list any additional training or skills related to the position to which you are applying, such as: computer software, iPad/tablet literacy, licenses (ex: CDL), certifications.

Other Information

Resume Upload

Applicant Authorization

Read carefully and initial in the box below the following statements.

I certify that the facts contained in this application and/or resume for employment at Price Electric Cooperative are true and complete to the best of my knowledge. I understand that any misrepresentations, falsifications, and/or deliberate omissions identified now or in the future will result in my immediate dismissal.

I authorize investigation of all statements herein. I also authorize by my signature below or a copy thereof, the organizations and individuals referred to herein to furnish information to the Cooperative. The Cooperative shall be held harmless should if, in processing this employment application, rely on information provided from these sources, even if the information provided is inaccurate or erroneous.

I understand that as a part of being considered for employment by Price Electric Cooperative, I will be required to undergo a physical examination that will require drug and/or alcohol testing.

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 Price 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 my employment is at-will. I understand that I have a right to terminate my employment at any time, for any reason, for no reason, and Price 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.

Signed:

Today's Date

Month

Day

Year

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