Step 1 of 5 0% Name(Required) First Last Email(Required) Position Desired(Required) Postion Type Part Time Full Time Current Address(Required) Street Address Address Line 2 City State 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 ZIP Code How long have you lived there?(Required) Previous Address Street Address Address Line 2 City State 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 ZIP Code How long did you live there? Have you ever worked for this company before?(Required) Yes No Please give dates and position(s) held Are you a close relative to any Director or Employee of Jasper County REMC?(Required) Yes No Please give name and relationship Have you ever pled guilty or "no contest" to, or been convicted of a misdemeanor or felony?(Required) Yes No Please give the date(s) and details Have you been arrested for any matters for which you currently are out on bail or on your own recognizance pending trial?(Required) Yes No Please give the date(s) and details Record of Previous EmploymentPlease list the names of your present and previous employers in chronological order with the present, or most recent, employer first. Be sure to account for all periods of time including military service and any periods of unemployment. If self-employed, give the name of the firm or business and supply business references. Use additional pages if needed.Present or Most Recent EmployerName of company or firm(Required) Address(Required) Street Address Address Line 2 City State 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 ZIP Code Business Phone(Required)Position or Title(Required) Employed From (mm/dd/yyyy)(Required) Month Day Year Employed To (mm/dd/yyyy)(Required) Month Day Year Starting Pay(Required)Final Pay(Required)Name and Title of Last Supervisor(Required) Reason for Leaving(Required)Add another job entry? Yes No Previous EmployerName of company or firm(Required) Address(Required) Street Address Address Line 2 City State 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 ZIP Code Business Phone(Required)Position or Title(Required) Employed From (mm/dd/yyyy)(Required) Month Day Year Employed To (mm/dd/yyyy)(Required) Month Day Year Starting Pay(Required)Final Pay(Required)Name and Title of Last Supervisor(Required) Reason for Leaving(Required)Add another job entry? Yes No Previous EmployerName of company or firm(Required) Address(Required) Street Address Address Line 2 City State 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 ZIP Code Business Phone(Required)Position or Title(Required) Employed From (mm/dd/yyyy)(Required) Month Day Year Employed To (mm/dd/yyyy)(Required) Month Day Year Starting Pay(Required)Final Pay(Required)Name and Title of Last Supervisor(Required) Reason for Leaving(Required)Add another job entry? Yes No Previous EmployerName of company or firm(Required) Address(Required) Street Address Address Line 2 City State 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 ZIP Code Business Phone(Required)Position or Title(Required) Employed From (mm/dd/yyyy)(Required) Month Day Year Employed To (mm/dd/yyyy)(Required) Month Day Year Starting Pay(Required)Final Pay(Required)Name and Title of Last Supervisor(Required) Reason for Leaving(Required)Add another job entry? Yes No Previous EmployerName of company or firm(Required) Address(Required) Street Address Address Line 2 City State 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 ZIP Code Business Phone(Required)Position or Title(Required) Employed From (mm/dd/yyyy)(Required) Month Day Year Employed To (mm/dd/yyyy)(Required) Month Day Year Starting Pay(Required)Final Pay(Required)Name and Title of Last Supervisor(Required) Reason for Leaving(Required)Have you ever been terminated or asked to resign from any job?(Required) Yes No Please explain circumstances(Required) Please explain fully any gaps in your employment historyMay we contact your current employer?(Required) Yes No Please explain(Required) Please indicate any actual experience, special training or qualification that you have that you feel is relevant to the position for which you are applying.Have you ever used another name?(Required) Yes No What other names?(Required) Is any additional information relative to any change of name, use of an assumed name, or nickname necessary to enable a check on your work and educational records?(Required) Yes No Please explain(Required) If hired, can you provide proof that you are authorizaed to work in the United States on an unrestricted basis?(Required) Yes No If hired, can you provide proof that you are over 18 years of age?(Required) Yes No Are you capable of satisfactorily performing the essential job duties of the position, with or without reasonable accommodation, for which you are applying?(Required)(Please review relevant job description) Yes No Do you have adequate transportation to and from work?(Required) Yes No EducationHigh SchoolYears CompletedDiploma/Degree Describe Course of Study or Major Describe Specialized Training, Experience, Skills, and Extra-Curricular ActivitiesCollege/UniversityYears CompletedDiploma/Degree Describe Course of Study or Major Describe Specialized Training, Experience, Skills, and Extra-Curricular ActivitiesGraduate/ProfessionalYears CompletedDiploma/Degree Describe Course of Study or Major Describe Specialized Training, Experience, Skills, and Extra-Curricular ActivitiesTrade/CorrespondenceYears CompletedDiploma/Degree Describe Course of Study or Major Describe Specialized Training, Experience, Skills, and Extra-Curricular ActivitiesOther Education Personal ReferencesPlease list 3 persons who know you well – not previous employers or relativesReference 1Name(Required) First Last Occupation(Required) Address(Required) Street Address Address Line 2 City State 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 ZIP Code Phone(Required)Number of Years Known(Required)Reference 2Name(Required) First Last Occupation(Required) Address(Required) Street Address Address Line 2 City State 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 ZIP Code Phone(Required)Number of Years Known(Required)Reference 3Name(Required) First Last Occupation(Required) Address(Required) Street Address Address Line 2 City State 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 ZIP Code Phone(Required)Number of Years Known(Required)Please upload a copy of your resume(Required)Max. file size: 150 MB.Additional DocumentsMax. file size: 150 MB. Applicant's Statement & AgreementConsent(Required)Work Rules. In the event of my employment with Jasper County REMC, I agree to comply with all rules and regulations of Jasper County REMC. Drug/Alcohol Test. I understand that Jasper County REMC reserves the right to require me to submit to a test for the presence of drugs in my system prior to employment and at any time during my employment to the extent permitted by law. Medical Examination. I understand that any offer of employment may be contingent upon the passing of a physical examination. I consent to the disclosure of the results of any physical examination or related tests to Jasper County REMC. I understand that should I decline to sign this consent or decline to take any of the above-described tests, my application for employment may be rejected or my employment may be terminated. Background Investigation. I understand that Jasper County REMC’s consideration of my application includes an investigation of the information I have provided on this application and other relevant information such as my driving record and criminal record, if any. I hereby authorize Jasper County REMC, or its designee, to investigate all statements contained in this application, including, but not limited to, interviewing personal references and past employers, performing credit checks, criminal history checks, and/or driver’s record checks. I hereby release all parties, including, but not limited to, Jasper County REMC from liability for any damages, losses, or claims that may result from information being obtained by or furnished to Jasper County REMC concerning me or any action Jasper County REMC takes on the basis of such information. Bond. I understand that bonding may be a condition of employment. If it is, I will be so advised either before or after hire and a bond application will have to be completed. At Will Employment. If hired, I further agree as follows: My employment and compensation are terminable at will, are for no definite period, and my employment and compensation may be terminated by Jasper County REMC (employer) at any time and for any reason whatsoever, with or without good cause at the option of either Jasper County REMC or myself. No implied, oral or written agreements contrary to the express language of this agreement are valid unless they are in writing and signed by the CEO of Jasper County REMC. Notwithstanding the foregoing, the terms of any collective bargaining agreement may apply to any applicant hired to work in a position subject to a collective bargaining agreement. I hereby certify that all the information that I have provided on this application or any other document filled out in connection with my employment, and any information that I have provided during any interview is true and correct. I have withheld nothing that would, if disclosed, effect this application unfavorably. I understand that if I am employed and any such information is later found to be false or incomplete in any respect, I may be dismissed. My signature below attests to the fact that I have read, understand, and agree to be legally bound by all of the below terms.Applicant Electronic Signature (Full Name)(Required)