Employment Opportunities

Full Name*

Address ^*

Street Address 1

Street Address 2

City ^*

State ^*

Zip Code ^*

Phone*

Social Security Number

Do you have the legal right to work in the United States? *

Yes No

How were you referred to the Cooperative?*

Have you ever applied for a job with the Cooperative? *

Yes No

If yes, when?*

Have you ever worked at the Cooperative before? *

Yes No

If yes, when?*

Positions for which you are applying (be specific)*

Salary Expected*

Are you at least eighteen years of age? *

Yes No

In what state or states do you possess a valid and current driver’s license?*

In what state or states have you ever possessed a driver’s license?*

Can you perform the essential functions of the job for which you are applying? (with or without reasonable accommodation – see job description for essential functions of the job for which you are applying. Applicants can view job descriptions here, or by contacting Rachel McSperitt to request a copy)*

If you are selected for employment, on what date can you start work?*

List any training or special skills you have that are relevant to the position for which you are applying.

List your membership in any professional or technical organizations that are related to the job requirements of the position for which you are applying. (Exlcude those that may disclose your age, race, religion, color, sec, national origin, physical or mental disability, veteran status, or union affiliations.)*

PERSONAL REFERENCES (Not Former Employers or Relatives)

Please list the Name and Occupation, Address and Phone Number of at least 3 references*

Apart from absence for religious observation, are you available to work from 8 a.m. to 5 p.m. Monday through Friday? *

Yes No

If not, what hours can you work?

Will you work overtime if asked? *

Yes No

Are you willing to work after hours call-out duty and on-call assignments?*

Yes No

Have you ever been convicted of a felony? *

Yes No

If yes, give details, including jurisdiction (state and county) where such conviction occurred. (Criminal convictions are not an absolute bar to employment. They will only be considered in relation to the specific job requirements.)*

Have you ever been convicted of power (electricity) theft or power diversion? *

Yes No

If yes, give details, including jurisdiction (state and county) where such conviction occurred.

EDUCATION

Highschool School Name*

Highschool Address*

Number of Years Attended*

College School Name

College Address

Number of Years Attended

Degree

Other School Name

Other School Address

Number of Years Attended

Other School Degree

Other School Major

Courses Now Studying

EMPLOYMENT (Most recent employer first)

Job 1: Dates Employed

Job 1: Name and Address of Employer

Job 1: Phone

Job 1: Title and Brief Description of Duties

Job 1: Supervisor

Job 1: Salary - Starting and Ending

Job 1: Exact Reason for Leaving

Job 1: May we contact them?

Yes No

Job 2: Dates Employed

Job 2: Name and Address of Employer

Job 2: Phone

Job 2: Title and Brief Description of Duties

Job 2: Supervisor

Job 2: Salary - Starting and Ending

Job 2: Exact Reason for Leaving

Job 2: May we contact them?

Yes No

Job 3: Dates Employed

Job 3: Name and Address of Employer

Job 3: Phone

Job 3: Title and Brief Description of Duties

Job 3: Supervisor

Job 3: Salary - Starting and Ending

Job 3: Exact Reason for Leaving

Job 3: May we contact them?

Yes No

Job 4: Dates Employed

Job 4: Name and Address of Employer

Job 4: Phone

Job 4: Title and Brief Description of Duties

Job 4: Supervisor

Job 4: Salary - Starting and Ending

Job 4: Exact Reason for Leaving

Job 4: May we contact them?

Yes No

Job 5: Dates Employed

Job 5: Name and Address of Employer

Job 5: Phone

Job 5: Title and Brief Description of Duties

Job 5: Supervisor

Job 5: Salary - Starting and Ending

Job 5: Exact Reason for Leaving

Job 5: May we contact them?

Yes No

List any special training or noteworthy achievements. Please email your resume to rmcsperitt@cooksonhills.com

SELF IDENTIFICATION OF SEX AND RACE

The Cooperative wishes to comply with various laws and regulations that require us to file annual statistical reports on the applicants for employment. Submission of the following information is voluntary. Any information you provide will be used by the Cooperative to comply with laws and regulations that require us to file annual statistical reports on applicants for employment. This information will be treated as confidential. Any information provided, or the failure to provide information, will not jeopardize or adversely affect your consideration for employment, nor will it be used to subject you to any adverse treatment.

Sex Classification

Male Female

Please Specify

EEO Classification

White (Not of Hispanic Origin) – All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East. Black (Not of Hispanic Origin) – All persons having origins in any of the Black racial groups of Africa. Hispanic – All persons of Mexican, Puerto Rican, Cuban, Central or South America, or other Spanish culture or origin, regardless of race Asian or Pacific Islander – All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area Includes, for example, China, Japan, Korea, the Philippine islands, and Samoa. American Indian or Alaskan Native – All persons having origins in any of the original peoples of North America, and who maintain cultural Identification through tribal affiliation of community recognition.

Please Specify

SELF IDNETIFICATION AND SPEICAL EMPLOYMENT NOTICE TO DISABLED VETERANS AND VIETNAM-ERA VETERANS

Cookson Hills Electric Cooperative, Inc. is a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era covered by the Act. If you are a disabled veteran or veteran of the Vietnam era covered by the Act and would like to be considered under the affirmative action program, please tell us. You may inform us of your desire to benefit under the program at this time and/or at any time in the future. This information will assist us in placing you in an appropriate position and in making accommodations for your disability if you are a disabled veteran. The Cooperative recruits, hires, upgrades, trains, and promotes in all job titles without regard to race, color, religion, sex, national origin, age, disability, or status as a disabled veteran or veteran of the Vietnam Era and makes every effort to reasonably accommodate the physical or mental limitations of disabled applicants and employees. Submission of this information is voluntary, and refusal to provide it will not subject you to any adverse treatment. Information you submit will be kept confidential, except that (I) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans and regarding necessary accommodations; (II) first aid and safety personnel may be informed, when and to the extent appropriate, if the condition might require emergency treatment; and (III) government officials engaged in enforcing laws administered by OFCCP or the Americans with Disabilities Act, may be informed. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veteran’s Readjustment Assistance Act of 1974, as amended. In order to assure proper placement of all employees, we do request that you answer the following questions. If you are disabled veteran of the Vietnam era, we would like to include you under the affirmative action program. If you are a disabled veteran, it would assist us if you answer the following questions.

What skills or procedures do you use or intend to use to perform the job notwithstanding your disability?

What accommodations can we make to enable yu to perform the job properly and safely, including special equipment, changes in the physical layout of the job, elimination of certain duties relating to the job, provision of personal assistance services, or other accommodations?

IMPORTANT READ THIS - CERTIFICATION

I certify that all information provided in support of my employment with the cooperative, including but not limited to this application, resumes, medical information, and information provided by me during interviews, is correct to the best of my knowledge, and I understand that misrepresentation or omission of relevant facts in seeking employment will result in my disqualification from further consideration or my dismissal from employment. I agree to conform to the rules and regulations of the cooperative, and I understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of the cooperative or myself. I further understand that no person is authorized to make any representation contrary to the above statement unless such representation is approved by the board of directors and is embodied in a written agreement signed by the president of the general manager of the cooperative. I further understand that if offered employment, I will be required to take a physical examination and that such examination will include blood, breath, urine, or saliva tests to determine the presence or use of alcohol or illegal controlled substances.

Yes, I certify the above statement is correct*

Yes

Please Specify

Sign your name as you would type it*

COOKSON HILLS ONLINE APPLICATION

PERSONAL REFERENCES (Not Former Employers or Relatives)

EDUCATION

EMPLOYMENT (Most recent employer first)

SELF IDENTIFICATION OF SEX AND RACE

SELF IDNETIFICATION AND SPEICAL EMPLOYMENT NOTICE TO DISABLED VETERANS AND VIETNAM-ERA VETERANS

IMPORTANT READ THIS - CERTIFICATION

Contact

SCAM ALERT!