EMPLOYMENT APPLICATION

Transcription

1 EMPLOYMENT APPLICATION The Middle Tennessee Electric Membership Corporation "An Equal Opportunity Employer M/F/D/V" Date If hired, Federal Law requires that you furnish documentation showing your identity and that you are legally authorized to work in the United States. TRANSCRIPT OF GRADES MUST BE ATTACHED IN ORDER FOR APPLICATION TO BE VALID. IF TRANSCRIPT IS UNAVAILABLE, MTEMC PERSONNEL HAS RIGHT TO OTHER SPECIFIED REQUIREMENTS. FIRST MIDDLE INITIAL LAST STREET CITY STATE ZIP TELEPHONE NUMBER SOCIAL SECURITY NUMBER Competitive Wages Friendly Work Environment Employee Training Advancement Opportunities Employee Benefits Service Awards Applications must be renewed for each job opening. ARE YOU LEGALLY ELIGIBLE YES ARE YOU 21 YEARS YES DO YOU USE YES FOR EMPLOYMENT IN THE USA NO OR OLDER? NO TOBACCO PRODUCTS? NO PRODUCT TYPE? ARE YOU RELATED TO ANY YES MTEMC EMPLOYEE? NO RELATIONSHIP HAVE YOU, SINCE THE AGE OF 18, EVER BEEN CONVICTED OF A FELONY? YES NO (NOTE: A CONVICTION WILL NOT NECESSARILY BAR YOU FROM EMPLOYMENT BUT WILL ONLY BE CONSIDERED IN RELATION TO SPECIFIC JOB REQUIREMENTS. EACH CONVICTION WILL BE JUDGED ON ITS OWN MERITS WITH RESPECT TO TIME, CIRCUMSTANCES, AND SERIOUSNESS.) IF YES, PLEASE SPECIFY: Our Mission... Quality Service POSITION YOU ARE APPLYING FOR TYPE OF WORK DESIRED The Middle Tennessee Electric Membership Corporation 555 New Salem Road Murfreesboro, Tennessee (615) For Office Use Only Interviewed by PAY EXPECTED PER WEEK DATE YOU WOULD BE AVAILABLE TO WORK? REASON FOR APPLYING WITH MTEMC WERE YOU PREVIOUSLY EMPLOYED BY US? YES NO WHEN? LIST THREE REFERENCES WHO ARE NOT RELATIVES OR PREVIOUS SUPERVISORS ZIP CODE OCCUPATION TELEPHONE Date of Hire Position Rate of Pay $

2 EDUCATION AND TRAINING SCHOOL AND OF SCHOOL COURSE OF STUDY HIGH COLLEGE OTHER (SPECIFY) CHECK LAST YEAR COMPLETED DID YOU GRADUATE? LIST DIPLOMA OR DEGREE WORK EXPERIENCE (YOUR CURRENT EMPLOYER WILL BE CONTACTED ONLY WITH YOUR CONSENT. PLEASE CHECK: YES NO) CURRENT OR MOST RECENT EMPLOYER: STARTING DATE: MO YR JOB TITLE SALARY $ LEAVING DATE: MO YR SUPERVISOR PHONE REASON FOR LEAVING DESCRIBE NATURE OF YOUR WORK SECOND MOST RECENT EMPLOYER; STARTING DATE: MO YR JOB TITLE SALARY $ LEAVING DATE: MO YR SUPERVISOR PHONE REASON FOR LEAVING DESCRIBE NATURE OF YOUR WORK THIRD MOST RECENT EMPLOYER: STARTING DATE: MO YR JOB TITLE SALARY $ LEAVING DATE: MO YR SUPERVISOR PHONE REASON FOR LEAVING DESCRIBE NATURE OF YOUR WORK YES NO YES NO YES NO MILITARY RECORD WERE YOU IN THE U.S. ARMED FORCES? YES NO BRANCH DATES OF DUTY: FROM TO DUTIES INCLUDING SPECIAL TRAINING HAVE YOU TAKEN ANY TRAIN- ING UNDER THE G.I. BILL OF RIGHTS? YES NO INFORMED CONSENT STATEMENT 1) I certify that the information contained on this application is correct to the best of my knowledge and understand that deliberate falsification of this information is grounds for dismissal. 2) I understand that a transcript of grades must be attached in order for this application to be valid. 3) I authorize the references listed to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. 4) I acknowledge that, if I become employed, I will be an employee at-will and will be free to terminate my employment for any reason and that The Middle Tennessee Electric Membership Corporation retains the same rights. Signature: Date:

3 Self-Identification of Race and Sex Position for Which You Are Applying: Name: Date of Application: The Middle Tennessee Electric Membership Corporation, by virtue of its federal contracts is subject to the equal employment opportunity and affirmative action obligations of Executive Order 11246, as amended, and its implementing regulations which require the Cooperative to conduct statistical analyses using data on the race and sex of applicants for employment, to be included in its Affirmative Action Program for Minorities and Women. Additionally, the Cooperative is required to submit this information to the U.S. Department of Labor s Office of Federal Contract Compliance Programs upon request. Completion of this form is voluntary. Any information you provide will be used by the Cooperative only to comply with its equal employment opportunity and affirmative action obligations under the law. Neither the information provided nor the failure to provide such information will adversely affect your consideration for employment or subject you to any other adverse treatment. This form will be maintained in a file separate from your application for employment and no one involved in the hiring process will have access to this information. ETHNICITY: Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. IDENTIFICATION OF RACE/ETHNICITY: American Indian or Alaskan Native (not Hispanic or Latino) A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment. Asian (not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Black or African American (not Hispanic or Latino) A person having origins in any of the Black racial groups of Africa. Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other pacific Islands. White (not Hispanic or Latino) A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Two or More Races (not Hispanic or Latino) All persons who identify with more than one of the above five races. IDENTIFICATION OF SEX: Female Male

4 Middle Tennessee Electric Membership Corporation Pre-Offer Invitation to Self-Identify as a Protected Veteran Middle Tennessee Electric Membership Corporation is a Government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows: A disabled veteran is one of the following: o a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or o a person who was discharged or released from active duty because of a service- connected disability. A recently separated veteran means any veteran during the three-year period beginning on the date of such veteran s discharge or release from active duty in the U.S. military, ground, naval, or air service. An active duty wartime or campaign badge veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An Armed forces service medal veteran means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order Protected veterans may have additional rights under USERRA - the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor s Veterans Employment and Training Service (VETS), toll-free, at USA DOL. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERAN LISTED ABOVE I AM NOT A PROTECTED VETERAN Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended. The 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 extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed. Middle Tennessee Electric Membership Corporation shall not discriminate against protected veterans and shall take affirmative action to employ and advance in employment qualified protected veterans at all levels of employment, including the executive level. Furthermore, Middle Tennessee Electric Membership Corporation will recruit, hire, train and promote persons in all job titles, and ensure that all other personnel actions are administered without regard to protected veteran status, and will ensure that all employment decisions are based only on valid job requirements. Name Date

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