Are you at least 18 years of age?
Yes
No
Are you legally authorized to work in the United States?
Yes
No
Do you possess a valid a current driver's license?
Yes
No
If no, please explain. If yes, please type N/A.
Can you perform the essential functions of the job for which you are applying either with or without a reasonable accommodation?
Yes
No
How were you referred to the Cooperative?
Union Rural Electric has an anti-nepotism policy and therefore needs to know if you are related to an employee or board member. Are you related to a current employee or board member?
Yes
No
If yes, what is the relationship? If no, please type N/A.
Have you ever applied for a job with Union Rural Electric Cooperative, Inc.?
Yes
No
If yes, when? If no, please type N/A.
Have you ever worked at a Cooperative before?
Yes
No
If yes, when? If no, please type N/A.
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. (Exclude those that may disclose your race, color, religion, sex (including pregnancy), national origin, ancestry, disability, age, veteran status or union affiliations.)
Are you able to travel overnight and be away from home?
Yes
No
Are you available to work from 7:30AM-4:00PM, Monday through Friday?
Yes
No
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 criminal offense excluding traffic violations?
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 specific job requirements.)
Have you ever been convicted of a power (electricity) theft or power diversion?
Yes
No
If yes, give details, including jurisdiction (state and county) where such conviction occurred.
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal, and I agree to hold my employer harmless in the event of my dismissal based thereon.
I authorize investigation of all statements contained herein and to do background checks to give you and all information concerning my previous employment and any pertinent information they may have, confidential or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.
I realize that under certain legal provisions, pre-employment drug testing could be a condition of my employment. I also acknowledge that the employer may require drug testing at a subsequent time providing that proper advance notice of testing is provided.
I also recognize that I could be offered employment subject to appropriate medical examination and that such a report could nullify my ultimate employment by this employer. I agree to submit to physical examination if required.
I understand and agree that, if hired, my employment is for no definite period and may, regardless of the method of payment of my wages and salary, be terminated at any time without prior notice. If employment is obtained under this application, I will comply with all the rules and policies of my employer."
AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER
This employer does not discriminate in hiring or employment on the basis of age, race, color, sex, religion, national origin, disability, military or veteran status
I understand and accept the