2328 Lovell Road
Knoxville, TN 37932
(865) 690-2521
Application For Employment
This is an application for employment with the West Knox Utility District. The application form is a source of information, which will assist WKUD in considering your suitability for the position for which you are applying. If successful in obtaining employment, such information requested will become part of the WKUD’s personnel records. Failure to supply the required information may prejudice the employer’s ability to determine your suitability for the position.
Personal Information
Work Status
Are you a citizen of the United States?
If no, are you authorized to work in the U.S.?
You will be required to provide evidence of your entitlementto work in the US (ie. production of a work permit orresidency papers)
Health Issues
You will be required to undergo a pre-employment medical check, the costs of which will be met by West Knox Utility District.
Do you have any known health condition of any kind, which may affect your ability to effectively carry out the functions and responsibilities of the position applied for?
Have you suffered any injury or illness that may affect your ability to effectively carry out the physical requirements, functions and responsibilities of the position applied for (eg, a previous back injury, Carpel Tunnel, Tennis Elbow or other repetitive strain injury)?
Are you on any medication which may affect your performance in the position that you have applied for?
Driver License
Do you hold a current State of Tennessee Driver’s License?
Has your Driver License been revoked or restricted within the last five years?
Is there any matter pending which could affect the status of your Driver License?
Have you ever been convicted of a felony?
Are you currently awaiting the hearing of any criminal charges?
Are you prepared to work overtime when required?
Are you prepared to travel and stay away from home overnight if required?
Are you prepared to work flexible hours if required?
Personal Interests/Hobbies
Additional Information/Hobbies
If this application is unsuccessful, do you consent to having your details held on file for a period of 6 months to be considered for vacancies that may arise?
    Education 2
    Education 3
Trade/Occupational Qualifications and Experience
Do you have any qualifications, knowledge, skills, or experience relevant to the position for which you are applying?
Employment Record
List your current or most recent employer first. Include periods of employment, travel and full-time study. (For further employment records, please continue a separate sheet.) Details may be shown on an attached file.
    Employer 2
    Employer 3
You are required to provide at least three references, preferably from your most recent employment. If you have not had previous employment, character referees are sufficient.
    Reference 1
    Reference 2
    Reference 3
I consent to WKUD seeking verbal or written information about me from representatives of my previous employers and/or references and authorize the information sought to be released for the purposes of ascertaining my suitability for the position I am applying for. I understand that the information received by the District is supplied in confidence as evaluative information, and as such will not be disclosed to me.
Signature :

1. Declare that to the best of my knowledge the answers to the questions in the application are true and correct and I understand that the information requested within this application form is sought to establish my suitability for the position that I am applying and that if I do not provide such information then this application for employment may be rejected.
2. Authorize any screening processes that WKUD sees fit to exercise in considering this application. I understand this process may include employer references and checking of criminal and medical records.
3. Am not aware of any personal circumstance, medical condition or disability that would limit my ability to adequately perform the role for which I seekemployment.
4. Accept that, should my application be successful, the foregoing information will form part of my employment records and falsification of any information is grounds for dismissal.
5. By returning this application electronically it is acknowledged that I fully agree with the above declaration.
Applicants invited to an interview will be required to sign this declaration
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