Carroll EMC Student Employee Job Application

Carroll EMC Student Employee Job Application
It is the practice of Carroll Electric Membership Corporation to accept Applications for Employment for existing vacancies only. You must submit a separate application for each position for which you desire to be considered. Your application will be valid for 90 days. Complete information should be furnished in order that we may give you fair and appropriate consideration. All employment practices shall ensure equal treatment of all employees, without discrimination toward, but not limited to, the following: employment, promotion, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay, benefits or any other forms of compensation, selection of training including apprenticeship, or other opportunities for advancement because of the employee's race, color, religion, sex, sexual orientation, gender identity, age, national origin, marital status, genetic information, disability, or veteran status.
NOTICE: Carroll EMC has a strong policy against drug and alcohol abuse. If you have a drug/alcohol abuse problem, it is suggested that you either identify the abuse problem immediately or do not complete the application.
DISCLAIMER: If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact 770-832-3552 or human.resources@cemc.com for assistance.
INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED

Are you a full-time high school or college student?*

YesNo
You must be a full-time high school or college student to be eligible for Carroll EMC's student position.

If you selected "No" for the question above, you are not an eligible applicant and should exit this form.
Please provide your hours of availability for each day, Monday through Friday.

PERSONAL DATA
Name*

First NameMiddle NameLast Name
Present Address*

Street Address

Street Address Line 2

CityState

Zip
Email Address
example@example.com
Primary Phone*

Area CodePhone Number
Business Phone

Area CodePhone Number

Last 4 Digits of Social Security Number
Are you 18 years of age or older?

YesNo
Position Desired:*

Community Relations Undergraduate Student
Date you can start:
Salary Range:
Have you ever been convicted of a felony? (Yes answer does not automatically disqualify you from employment)*

YesNo
If yes, explain below:
Have you ever worked for this company before?*

YesNo
If yes, when:

MILITARY
Branch of U.S. military service:
Grade or Rank at Discharge:
Service Date(s) - From When to When:
Applicable Military Experience:

EDUCATION

	Name of School	Location	Number of Years Attended	Did You Graduate?	Degree or Certificate	Major
High School(s)
College or University

Business or Technical

List all professional licenses/certificates you have acquired relevant to the position applied for:
REFERENCES

Please give the names of three references who have given you their permission to contact. We must have at least two former supervisors and preferably one professional contact at your workplace. No personal references please.

	Name	Professional Relationship to you	Company	Phone
1.
2.
3.

RECORD OF EMPLOYMENT

(List present or last employer first)
PRESENT
Company Name
Type of Business
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Employed From (state month and year) / Started
Employed From (state month and year) / Ended
Wage/Salary Range
Name and Title of Supervisor
Your title and brief description of your duties (Do Not Put "See Resume")
Reason for Leaving

PREVIOUS
Company Name
Type of Business
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Employed From (state month and year) / Started
Employed From (state month and year) / Ended
Wage/Salary Range
Name and Title of Supervisor
Your title and brief description of your duties (Do Not Put "See Resume")
Reason for Leaving

PREVIOUS
Company Name
Type of Business
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Employed From (state month and year) / Started
Employed From (state month and year) / Ended
Wage/Salary Range
Name and Title of Supervisor
Your title and brief description of your duties (Do Not Put "See Resume")
Reason for Leaving

PREVIOUS
Company Name
Type of Business
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Employed From (state month & year) / Started
Employed From (state month & year) / Ended
Wage/Salary Range
Name & Title of Supervisor
Your title and brief description of your duties (Do Not Put "See Resume")
Reason for Leaving

EMERGENCY

In case of emergency notify:
Name*

First NameLast Name
Phone*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState

Zip Code

JOB APPLICANT'S AGREEMENT

(Read carefully and sign)
1. I represent that all information on this application and on any other forms completed or to be completed by in connection with my application to be true and correct. I understand that any misrepresentation or concealment of information requested will be reason for immediate dismissal if I am employed. I hereby certify that I am physically able to perform the essential function of the position with or without accomodations.

2. Any employment offer and my employment is conditional until certain required information has been satisfactorily reviewed and verified (i.e., evaluation of pre-placement health assessments; drug screening where applicable, reference checks; acknowledgment of Carroll EMC's Employment Handbook, school transcripts, if applicable, employment eligibility verification; conflict of interest acknowledgment; and Carroll EMC's equal opportunity policy).

3. This application is not an employment contract and should not be construed or interpreted as creating an implied or expressed contract of employment between Carroll EMC and its employees. The employment relationship is by mutual consent (employment-at-will) and employees have their right, at any time, to terminate employment, for any reason. Carroll EMC reserves the right to terminate employees on the same basis.

4. I authorize those individuals or companies contracted to disclose to Carroll EMC all records and information pertinent to my employment with Carroll EMC. In addition, I hereby fully waive any right of claims I have or may have against my former employers, their agents, employees, and representatives, as well as others who release information to Carroll EMC. I understand this authorization to be part of the written employment application which I sign.

5. I am not acting as an agent of any individual, organization or agent to "test" the lawfulness or propriety of Carroll EMC's hiring policies or practices.
Applicant's Signature*

Clear
Date*

MonthDayYear
Date
Please upload your resume, if available.
Browse Files

Cancelof

CARROLL ELECTRIC MEMBERSHIP CORPORATION / 155 N. Hwy. 113 / Carrollton, Georgia 30117
AN AFFIRMATIVE ACTION, EQUAL OPPORTUNITY PROVIDER AND EMPLOYER

M/F/vet/disability
Invitation to Self-Identify
This company is subject to Executive Order 11246, as amended, which requires Federal contractors to ensure that applicants are employed and that employees are treated during employment without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. We are therefore requesting information about race and gender in order to comply with government reporting requirements and in order to ensure equal employment opportunity.

Submission of this information is voluntary and will be kept confidential. 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 Federal affirmative action regulations.
Name:

First NameLast Name
Date:

MonthDayYear
Date
Position:

This company is also subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as ameded by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment veterans in the following classificiations:
- A "disabled veteran" is one of the following:
  - 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
  - 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 Deparment 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 12985.
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 ABOVEI AM NOT A PROTECTED VETERAN

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do I know if I have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability.

Disabilities include, but are not limited to:
- Alcohol or other substance use disorder (not currently using drugs illegally)
- Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
- Blind or low vision
- Cancer (past or present)
- Cardiovascular or heart disease
- Celiac disease
- Cerebral palsy
- Deaf or serious difficulty hearing
- Diabetes
- Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
- Epilepsy or other seizure disorder
- Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
- Intellectual or developmental disability
- Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
- Missing limbs or partially missing limbs
- Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
- Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
- Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
- Partial or complete paralysis (any cause)
- Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
- Short stature (dwarfism)
- Traumatic brain injury

Please check one of the boxes below:

YES, I HAVE A DISABILITY, OR HAVE HAD ONE IN THE PASTNO, I DO NOT HAVE A DISABILITY AND HAVE NOT HAD ONE IN THE PASTI DO NOT WISH TO ANSWER
Your Name

First NameLast Name
Today's Date

MonthDayYear
Date
Form CC-305 / OMB Control Number 1250-0005

Voluntary Self-Identification of Disability

Reasonable Accomodation Notice

Federal law requires employers to provide reasonable accomodation to qualified individuals with disabilities.¹ Please tell us if you require a reasonable accomodation to apply for a job or to perform your job. Examples of reasonable accomodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
¹ Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Program (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperword Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
Form CC-305 / OMB Control Number 1250-0005
Should be Empty: