Job Opening: Laborer Laborer Application Step 1 of 6 16% Your Personal InformationYour Name(Required) First Last Your Phone(Required)Your Email Address(Required) Address(Required) Street Address Address Line 2 City State ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Desired SalaryDate Available MM slash DD slash YYYY Best Time To Call You(Required)When is the best time for us to reach you via telephone?MorningsNoonAfternoonPosition Applied for(Required)Are you authorized to work in the U.S.Proof of authorization will be required under federal law if employment begins. Yes No Other Have you ever worked for this company?(Required) Yes No If yes, when?Have you ever been convicted of a felony?Conviction is not necessarily a bar to employment. We will consider the nature and gravity of the offense, when it occurred, and the nature of the job sought. Yes No If yes, please explain. EducationHigh School(Required)Did you graduate?(Required) Yes No Other Address City State College(Required)Address City State Did you graduate?(Required) Yes No Other Degree/CertificateFrom MM slash DD slash YYYY To MM slash DD slash YYYY OtherOtherAddress City State Did you graduate? Yes No Other Degree/CertificateFrom MM slash DD slash YYYY To MM slash DD slash YYYY Current EmploymentCurrent Employer(Required)Please list your current employer, the dates you worked and the position you heldEmployerDatesPositionPhone Add RemoveAddress Street Address City State Supervisor First Last May we contact your supervisor for a reference?(Required) Yes No Other Reason for LeavingResponsibilities(Required)Previous EmploymentYour Previous EmployerPlease list your previous employers, the dates you worked and the position you heldEmployerDatesPositionPhone Add RemoveAddress Street Address City State Supervisor First Last May we contact your supervisor for a reference? Yes No Other Reason for LeavingResponsibilitiesYour Previous EmployerPlease list your previous employers, the dates you worked and the position you heldEmployerDatesPositionPhone Add RemoveAddress Street Address City State Supervisor First Last May we contact your supervisor for a reference? Yes No Other Reason for LeavingResponsibilities ReferencesReference 1(Required) First Last CompanyAddress Street Address City State ZIP / Postal Code Phone(Required)Relationship to Applicant(Required)Reference 2(Required) First Last CompanyAddress Street Address City State ZIP / Postal Code Phone(Required)Relationship to Applicant(Required)Reference 3(Required) First Last CompanyAddress Street Address City State ZIP / Postal Code Phone(Required)Relationship to Applicant(Required) Military ServiceBranchFrom MM slash DD slash YYYY To MM slash DD slash YYYY Rank at DischargeSpecial TrainingService Awards Terms and Conditions(Required)I hereby declare that the information, which is being provided by me in this application for employment, is true, correct, and complete to the best of my knowledge. I understand that falsification of this application in any way whatsoever, or misstatement or omission of fact on this application, shall be grounds to deny me employment. If Pickwick Electric Cooperative (“PEC”) employs me, I understand that this application will become part of my official employment record. I further understand that falsification of this application in any way whatsoever, or misstatement or omission of fact on this application, shall be considered cause for immediate dismissal, regardless of when the falsification, misstatement or omission is discovered. I authorize PEC to obtain investigative reports containing information as to my character, personal characteristics, and work experience. I understand that I have the right to make a written request (within a reasonable period of time) to receive information regarding the investigation. I hereby give consent to any and all prior employers of mine to provide information with regard to my employment with prior employers to PEC. I understand and acknowledge that if employed, my employment with PEC will be “at will”, meaning that either I or PEC may terminate my employment at any time for any reason or no reason, unless the “at will” arrangement is modified by an applicable collective bargaining agreement, or a written agreement signed by both the President of PEC and me. I acknowledge that I do not rely and have not relied on any representations or statements made by PEC or any of its agents or representatives, whether oral or written, that are inconsistent with, or differ in any way from, the statements presented in this application. I understand that no agent or representative of PEC, other than the President, has any authority to enter into any agreement, oral or written, for employment for any specified period of time or to make any agreement or assurances contrary to the “at will” nature of the employment relationship. I also understand that this application is not a contract of employment. I specifically understand and acknowledge that if I am employed, my “at will” employment with PEC is for no specific duration and can be terminated at any time. By my signature on this application, I authorize PEC to conduct reference checks, with former employers and other persons named in this application, for the purposes of providing the Company with any relevant information which is required for employment, and I release all persons contacted by PEC during the hiring process from any liability for any damage whatsoever resulting from giving the Company this information. Should PEC employ me, I authorize its representatives to furnish information regarding my employment at the Company if such information is requested in the future. I release PEC and its representatives from any liability for any damage whatsoever resulting from furnishing this information. I have read and understand the contents of this employment application and am fully able and competent to complete it. I voluntarily consent and agree to the foregoing statements. I agree to the terms and conditions.Signature(Required)Date(Required) MM slash DD slash YYYY Upload Your ResumeUpload your resume in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 25 MB. Section Break
