CompanyThis field is for validation purposes and should be left unchanged.1803 Electric Cooperative, Inc. (“1803”) is committed to a policy of equal employment opportunity and will not discriminate against an applicant or employee based on race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, childbirth and related medical conditions, sexual orientation, and gender identity), age, physical or mental disability, sickle cell trait, veteran or military status, genetic information, citizenship, or any other legally recognized protected basis under federal, state, or local law. Applicants with disabilities may be entitled to reasonable accommodation under the Americans with Disabilities Act and other applicable laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on 1803. Please inform the company’s personnel representative if you need assistance completing this application or to otherwise participate in the application process. The information collected through this application is solely to determine suitability for employment. Your application will be active for 60 days. If you are not hired during that time but wish to continue to be considered for available positions, you must complete a new application. Upon employment, employees of 1803 may be required to have their picture taken or to provide 1803 with a picture of themselves.Name(Required) First Middle Last Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Alternate Phone(Required)Date available for work(Required) Email(Required) Are you legally authorized to work in the United States?(Required) Yes No Do you now, or will you in the future, require immigration sponsorship for work authorization (e.g., H-1B)?(Required)If hired, verification will be required consistent with applicable law. Yes No If hired, would you have a reliable means of transportation to and from work?(Required) Yes No Do you have a driver’s license?(Required) Yes No Operator Commercial (CDL) Driver’s license number(Required)State of issue(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificExpiration date(Required) Position InformationPosition applied for:(Required)Applying for:(Required) Full-time Part-time Seasonal/Temporary EducationHigh School Name(Required)School LocationDiploma, Degree, or Certificate ReceivedWould you like to add another college or trade school? Yes, I'd like to add another No, I am ready to move on to the next section College or Trade School NameDiploma, Degree, or Certificate ReceivedCourse of Study or MajorWould you like to add another college or trade school? Yes, I'd like to add another No, I am ready to move on to the next section College or Trade School NameDiploma, Degree, or Certificate ReceivedCourse of Study or MajorBackground InformationDuring the past seven years, have you ever been terminated, suspended, or asked to resign from any position?(Required) Yes No Please explainFor the purpose of verifying information on this application, have you ever worked or attended school under a different name at any of the companies or institutions you have listed? Yes No Specify name(Required)1803 will consider qualified applicants, including those with criminal histories, in a manner consistent with federal, state, and local laws.Employment RecordList all employment experience for the past seven years, starting with the most recent or present employer, including US military service or training. Using a separate section for each position, describe in detail all work experience. You may include as part of your employment history any verifiable work performed on a volunteer basis. Resumes may not be substituted in place of completing the following employment information.Current or Most Recent Employer(Required)Geographic Location(Required)Your Position(Required)Primary Responsibilities(Required)Click + to add additional responsibilities Add RemoveSupervisor’s Name(Required)Supervisor’s Title(Required)May we contact them?(Required) Yes No PhoneStart Date(Required) End Date (Leave blank if current) Would you like to add another employer(Required) Yes, I'd like to add another No, I am ready to move on to the next section Previous Employer(Required)Geographic Location(Required)Your Position(Required)Primary Responsibilities(Required)Click + to add additional responsibilities Add RemoveSupervisor’s Name(Required)Supervisor’s Title(Required)May we contact them?(Required) Yes No PhoneStart Date End Date Previous Employer(Required)Geographic Location(Required)Your Position(Required)Primary Responsibilities(Required)Click + to add additional responsibilities Add RemoveSupervisor’s Name(Required)Supervisor’s Title(Required)May we contact them?(Required) Yes No PhoneStart Date End Date References #1 (of 3)Name First Last PhoneEmail Type of Reference Personal Professional Reference #2 (of 3)Name First Last Name First Last PhoneEmail Type of Reference Personal Professional Reference #3 (of 3)Name First Last PhoneEmail Type of Reference Personal Professional How did you learn about the open position(s)? Check all that apply Website Recruiter Word of Mouth Careers website or job board (Monster, Indeed, CareerBuilder, etc.) Social media (LinkedIn, Facebook, etc.) Other Have you signed or otherwise agreed to any non-solicitation, non-compete, or other similar post-employment restriction or agreement with your current or any prior employer?(Required) Yes No Please explainPlease Upload Resume and Cover Letter here Drop files here or Select files Max. file size: 100 MB. Acknowledgment and CertificationsPLEASE READ CAREFULLY AND INITIAL EACH PARAGRAPH BEFORE SIGNINGConcent(Required) I understand that, where permissible under applicable federal, state, or local law, I may be subject to a pre-employment drug test after receiving a conditional offer of employment and must receive a negative test result before being permitted to commence work with 1803.(Required)Concent(Required) I understand that, where permissible under applicable federal, state, or local law, I may be subject to a pre-employment medical examination after receiving a conditional offer of employment and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with 1803.(Required)Concent(Required) I understand that, where permissible under applicable federal, state, or local law, I may be subject to a pre-employment background check after receiving a conditional offer of employment to investigate my criminal background, driving record, credit history, and other matters related to my suitability for employment. I understand that a separate disclosure and consent form will be provided to me prior to any background check.(Required)Concent(Required) I understand that employment with 1803 is contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.(Required)Concent(Required) I authorize 1803 and its representatives to contact my current and former employers (with the exception of my current employer, if I have marked “May we contact?” in relation to your employment record reflected in this application), schools, references, and other persons I have named in this application for the purpose of verifying the information I have provided. I release my current and former employers, schools, references, and other persons named in this application from any liability resulting from the information released. I authorize employers, schools, and other persons named in this application to provide any information or transcripts requested.(Required)Concent(Required) I hereby certify that, if employed, my employment with 1803 will not conflict with, violate, breach, or result in default under, any contract, agreement, or understanding that to which I am a party or to which I am bound, including any non-solicitation, non-compete, or other similar post-employment restriction or agreement I have with any current or former employer(Required)Concent(Required) I understand and agree that, if hired, my employment will be at will, which means employment is for an indefinite period of time and may be terminated by myself or 1803 at any time, with or without cause, and with or without notice.(Required)Concent(Required) I certify that all of the above information is true and complete and I understand that any falsification or omission of information made by me may disqualify me from further consideration for employment or, if hired, may result in my termination at any time during the period of my employment, regardless of the amount of time that has passed.(Required)Member/Applicant Electronic Signature (Full Name)(Required)I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.
