JOB POSITION

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PERSONAL INFORMATION

If you are under 18 years of age, can you provide required proof of your eligibility to work?

YesNo

Have you ever filed an application with us before?

YesNo

If yes, give date:

Have you ever been employed with us before?

YesNo

If yes, give date:

Are you currently employed?

YesNo

May we contact your present employer?

YesNo

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? Proof of citizenship or immigration status will be required upon employment.

YesNo

On what date would you be available for work?

Are you available to work:

Full TimePart TimeShift WorkTemporary

Are you currently on "lay-off" status and subject to recall?

YesNo

Can you travel if a job requires it?

YesNo

EDUCATION

ELEMENTARY SCHOOL

HIGH SCHOOL

UNDERGRADUATE COLLEGE

GRADUATE PROFESSIONAL

OTHER (SPECIFY)

Describe any specialized training, apprenticeship, skills, extra-curricular activities, and any professional civic activities:

Describe any job-related training received in the United States Military:

EMPLOYMENT EXPERIENCE

Start with your present or last job. Include any job-related military service assignments and voluntary activities. You may exclude organizations which indicate, race, color, religion, gender, national origin, disabilities or other protected status.

EMPLOYER 1

Dates Employed

Work Performed:

Reason for Leaving:

EMPLOYER 2

Dates Employed

Work Performed:

Reason for Leaving:

ADDITIONAL INFORMATION

Summarize special job-related skills and qualifications acquired from employment or other experience:

Check specialized-skills/equipment operated.

Data EntryPCEmailWordFaxWindowsExcelAdding Machine

List Production/Mobile Machinery you have experience operating:

List any other specialized skills:

State any additional information you feel may be helpful to us in considering your application:

Note to Applicants: Do not answer this question unless you have been informed about the requirements of the job for which you are applying.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A description of the activities in such a job or occupation is attached.

YesNo

REFERENCES

REFERENCE ONE

REFERENCE TWO

REFERENCE THREE

POLICY #3.4

In accordance with Southern Illinois Power Cooperative's Policy #3.4, Nepotism and the Appearance of Impropriety, the Cooperative shall not hire a member of the immediate family of a current employee, the General Manager or a member of the Board of Directors or Manager of a member-system cooperative.

Immediate family includes the following whether by blood or marriage: children, parents, sister, brother, aunt, uncle, niece, nephew, grandchild, or grandparent. This also includes all in-law and step relations.

Is there anyone currently employed with the Cooperative that is a member of your immediate family as described above?

YesNo

If so, who:

APPLICANT STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

ADDITIONAL IDENTIFICATION FORMS

The following three forms are voluntary and are not required to be completed.

Voluntary Self Identification FormVoluntary Self Identification Of Disability Form CC-305Voluntary Veteran Self Identification Form

Instructions to Submit Additional Information

• Clicking the link on the form will open it in a new window

• Print the form and close the new window

• Complete the form

• Mail the form to the below address

• Do not forget to click on the 'Submit Information' button to complete the online application

Mailing AddressSouthern Illinois Power CooperativeAttention: Diane Karnes11543 Lake of Egypt RoadMarion, IL 62959