Employment Application

WEST KNOX UTILITY DISTRICT
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.

What Position are you applying for?

Desired Salary:

Personal Information

Name (Last Name First)

Address:

City :

State

Zip Code :

Home Phone :

Mobile Phone :

Email :

Work Status

Are you a citizen of the United States?

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

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?

Yes

No

If yes, give details

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)?

Yes

No

If yes, give details

Are you on any medication which may affect your performance in the position that you have applied for?

Yes

No

If yes, give details

Driver License

Do you hold a current State of Tennessee Driver’s License?

Yes

No

If yes, Number :

Class :

Expiration Date : +

No. of Demerit Points :

Has your Driver License been revoked or restricted within the last five years?

Yes

No

Is there any matter pending which could affect the status of your Driver License?

Yes

No

General

Have you ever been convicted of a felony?

Yes

No

If yes, give details

Are you currently awaiting the hearing of any criminal charges?

Yes

No

Are you prepared to work overtime when required?

Yes

No

Are you prepared to travel and stay away from home overnight if required?

Yes

No

Are you prepared to work flexible hours if required?

Yes

No

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?

Yes

No

If your application is successful, when could you start work? +

Education

Name of School / Technical Institute / University / etc.

From +

To +

Qualifications Obtained

Education 2

Name of School / Technical Institute / University / etc.

From +

To +

Qualifications Obtained

Education 3

Name of School / Technical Institute / University / etc.

From +

To +

Qualifications Obtained

Trade/Occupational Qualifications and Experience

Do you have any qualifications, knowledge, skills, or experience relevant to the position for which you are applying?

Yes

No

If so, give details below

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.

Current/Past Employer

Employed From +

Employed To +

Position :

Reporting To :

Responsible for :

Reason For Leaving

Employer 2

Current/Past Employer

Employed From +

Employed To +

Position :

Reporting To :

Responsible for :

Reason For Leaving

Employer 3

Current/Past Employer

Employed From +

Employed To +

Position :

Reporting To :

Responsible for :

Reason For Leaving

References

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

Name Of Person To Contact

Relationship To You ((Employer/Colleage/Neighbor/Friend)

Phone Number

Reference 2

Name Of Person To Contact

Relationship To You ((Employer/Colleage/Neighbor/Friend)

Phone Number

Reference 3

Name Of Person To Contact

Relationship To You ((Employer/Colleage/Neighbor/Friend)

Phone Number

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 :

clear

Date : +

Attach Resume' If Available

Declaration

I,

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

Signature

clear

Date +