Employment Application

NORTHEAST LOUISIANA POWER COOPERATIVE, INC. places great emphasis on customer service, teamwork, problem solving, and innovation. We look for people who exemplify these qualities and are willing to work hard for our membership. Northeast Louisiana Power Cooperative, Inc. is an equal opportunity employer.

Applicant Name*

Today's Date*

Personal Information (Please Print Clearly)

Name*

First NameLast Name

Street Address*

City*

State*

Zip Code*

Previous address if less than 5 years at current address

Home Phone*

Format: (000) 000-0000.

Work Phone

Format: (000) 000-0000.

Fax

Email

example@example.com

I understand that upon employment, proof of legal right to work in the United States and completion of I-9 form will be required. Are you eligible to work for any United States employer at this time?*

YesNo

If you are under 18 years of age, do you have a work permit?

YesNo

Have you ever been convicted of a felony?*

YesNo

If yes explain

Do you have a valid driver's license?*

YesNo

License #*

Expires*

Do you have a valid Commercial Driver's License (CDL)?*

YesNo

License #*

Expires*

Can you travel if the position requires travel?*

YesNo

If you have ever worked under or earned degrees under another name, please list below:

Last Name

First Name

Position Applied for*

How did you learn of this vacancy?

Salary Desired (Annual)

Date Available*

Are you able to perform the essential functions of this position?*

YesNo

If no, what accommodation would make it possible for you to perform this job?

Have you previously been employed by Northeast Louisiana Power Cooperative or other electric cooperatives?*

YesNo

If yes, indicate position, department, and dates.

Do you have any relatives employed at Northeast Louisiana Power?*

YesNo

If Yes, who?

Northeast Louisiana Power Cooperative, Inc. is an equal opportunity employer and recruits, advertises, employs, promotes, transfers, disciplines, and discharges without regard to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, or veteran status.

Indicate Last Level of Education Completed

High School

1234

College or University

1234

Graduate School

1234

Education History

Rows	Type of Education	Name and Location (City, State)	GPA	Graduated?	Major/Minor	Degree Earned
1.
2.
3.
4.

Professional certifications and licenses (such as CPA, NASD series 6)

Computer skills (software programs, hardware, operating systems)

Other skills or experience that are pertinent to the job applied for

List your last three employers with the most recent first.

List your last three employers with the most recent first. If you are currently employed, may we contact your employer?

YesNo

Previous Employer 1

Address

From Month/Year

To Month/Year

Starting Salary

Ending Salary

Supervisor's Phone Number

Supervisor's Name

Supervisor's Job Title

Your Job Title

Your Job Duties

Reason for leaving

Previous Employer 2

Address

From Month/Year

To Month/Year

Starting Salary

Ending Salary

Supervisor's Phone Number

Supervisor's Name

Supervisor's Job Title

Your Job Title

Your Job Duties

Reason for leaving

Previous Employer 3

Address

From Month/Year

To Month/Year

Starting Salary

Ending Salary

Supervisor's Phone Number

Supervisor's Name

Supervisor's Job Title

Your Job Title

Your Job Duties

Reason for leaving

Professional References (please list only references we may contact at this time)

Rows	Name	Title	Company	Phone Number
1.
2.
3.

Affidavit

Nonbinding Application and Interview Process: I understand that this application will be reviewed, but nothing in this application or any other documents or in the employment evaluation process shall be construed as either an offer or contract of employment or an obligation on the part of Northeast Louisiana Power Cooperative, Inc. to provide any benefit to me.

Employment-At-Will: I understand that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either Northeast Louisiana Power Cooperative, Inc. or myself.

I hereby declare that my statements on this application and on my resume or documents provided by me to Northeast Louisiana Power Cooperative, Inc., are true and correct to the best of my knowledge. I acknowledge and agree that providing any false information may result in a decision not to hire me, or if hired, may result in the termination of my employment. I also authorize investigation of these statements. This investigation may include employment history, reasons leaving previous employers, criminal record, credit record, driving record, social security number investigation, and degree/certificate verification. I hereby release Northeast Louisiana Power Cooperative, Inc. from all liability for any damages resulting from the information obtained. This application shall be considered active for a period of time not to exceed 180 days.

APPLICANTS SIGNATURE*

Education and Training

Employment History