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Employment Application

UPPER CUMBERLAND ELECTRIC MEMBERSHIP CORPORATION - APPLICATION FOR EMPLOYMENT
907 Main St N, Carthage, TN 37030

Note: Applicants applying for positions that require them to drive Cooperative vehicles must also fill out the Driver's Supplemental Application for Employment.

This application will be considered only for the vacant position for which you are applying. To be considered for other vacant positions, you must call to update this application. This application will remain active for twelve months after this position has been filled. The following information is requested in order to help us make the best possible placement within the Cooperative. All portions of this application pertaining to you must be completed. We appreciate the time you spend in filling in this application form.

The Cooperative, in accordance with state and federal laws, does not discriminate on the basis of race, creed, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, or veteran status. The Cooperative is also required by law, by virtue of its contract(s) with the federal government, to take affirmative action to employ women, minorities, otherwise qualified disabled individuals, and Vietnam Era and disabled veterans.

UPPER CUMBERLAND ELECTRIC MEMBERSHIP CORPORATION IS AN EQUAL OPPORTUNITY EMPLOYER.

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT

Job Posting Select Posting to Apply for:

Personal

First Name:

Middle Name:

Last Name:

Home Phone:

Work Phone:

Cell Phone:

Email Address:

Addresses

Current Address

Street:

City:

State:

Zip Code:

Since (Mo/Yr):

Education

High School

School:

City:

State:

Diploma:

No Yes

Undergrad School

School:

City:

State:

Diploma:

No Yes

Deg/Cert/Dip:

Area of Study:

Grad School

School:

City:

State

Diploma:

No Yes

Deg/Cert/Dip:

Area of Study:

Other School

School:

City:

State:

Diploma:

No Yes

Deg/Cert/Dip:

Area of Study:

Employment

Employment Information

Position Applied For:

Date You Can Start:

(yyyy-mm-dd)

Desired Salary ($):

Do You Prefer:

Can you work overtime?: Weekends Evenings

What days of the week are you available to work?: M Tu W Th F Sa Su

Apart from absense for religious observation, are you available to work from 7 a.m. to 4:30 p.m. Monday thru Friday?:

No Yes

If not, what hours can you work?:

Please answer all of the following questions.

1) Do you have the right to work in the United States?

No Yes

Are you at least eighteen years of age?

No Yes

2) Have you ever applied for a job with the Cooperative?

No Yes

If yes, when?

3) Are you a relative, either by blood or marriage, of any employee or Director of the Cooperative?

No Yes

4) Did you hear about this job opening via Website, Social Media, Newspaper, Radio or Television?

No Yes

Please clarify - Website, Social Media, Newspaper, Radio OR Television?

5) Were you referred to the Cooperative?

No Yes

6) Have you ever worked at the Cooperative before?

No Yes

If yes, please explain.

7) Have you ever been convicted of a felony?

No Yes

If yes, give details, including jurisdiction (state and county) where such conviction occurred. Criminal convictions are not an absolute bar to employment. They will only be considered in relation to specific job requirements.

8) Have you ever been convicted of a power (electricity) theft or power diversion?

No Yes

If yes, give details, including jurisdiction (state and county) where such conviction occurred.

Employers

Are you currently employed?

No Yes

May we contact your current employer?

No Yes

Most Recent Employer

Employer:

City:

State:

Zip Code:

Phone:

Position Held:

From (m/yyyy):

To (m/yyyy):

Pay upon leaving:

Supervisor:

Duties:

Reason for Leaving:

Previous Employer

Employer:

City:

State:

Zip Code:

Phone:

Position Held:

From (m/yyyy):

To (m/yyyy):

Pay upon leaving:

Supervisor:

Duties:

Reason for Leaving:

Previous Employer

Employer:

City:

State:

Zip Code:

Phone:

Position Held:

From (m/yyyy):

To (m/yyyy):

Pay upon leaving:

Supervisor:

Duties:

Reason for Leaving:

Previous Employer

Employer:

City:

State:

Zip Code:

Phone:

Position Held:

From (m/yyyy):

To (m/yyyy):

Pay upon leaving:

Supervisor:

Duties:

Reason for Leaving:

Drivers License Details

Please answer the following questions if the position you are applying for requires driving a motor vehicle:

1) Do you have a valid driver's license?

No Yes

If yes, Please Provide Your Driver's License Number:

Date of Driver's Licence Issue?:

2) Have you been convicted of or pled guilty to any traffic-related offense within the past five years?

No Yes

If yes, please explain...

3) Have you had your driver's license suspended or revoked or had your driving privileges modified by a court of law?

No Yes

If yes, please explain...

4) Please list all states from which you hold or held a driver's license. Please include your license number for each state.:

Training OR Special Skills?
List any training or special skills you have that are relevant to the position for which you are applying.

Professional Memberships OR Technical Organizations?
List your membership in any professional or technical organizations that are related to the job requirements of the position for which you are applying. (Exclude those that may disclose your race, creed, color, religion, sex (including pregnancy), national origin, age, disability, veteran status, or union affiliations.

PERSONAL REFERENCES (Please do not list any former UCEMC Employees, UCEMC Relatives OR UCEMC Board of Directors.)

Reference

Name & Occupation:

Email:

Address:

Telephone:

Relationship:

Years Acquainted:

Reference

Name & Occupation:

Email:

Address:

Telephone:

Relationship:

Years Acquainted:

Reference

Name & Occupation:

Email:

Address:

Telephone:

Relationship:

Years Acquainted:

Reference

Name & Occupation:

Email:

Address:

Telephone:

Relationship:

Years Acquainted:

Resumes

Resume (Text Version)

Copy and Paste a text version of your resume here.

Upload Resume

Attach a file to your application submission (Permitted File Types: doc,docx,pdf,txt - Max file size: 1045876 bytes)

Agreement

Applicant Certification Agreement

I CERTIFY THAT ALL INFORMATION PROVIDED IN SUPPORT OF MY EMPLOYMENT WITH THE COOPERATIVE, INCLUDING BUT NOT LIMITED TO THIS APPLICATION, RESUMES, MEDICAL INFORMATION, AND INFORMATION PROVIDED BY ME DURING INTERVIEWS, IS CORRECT TO THE BEST OF MY KNOWLEDGE, AND I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF RELEVANT FACTS IN SEEKING EMPLOYMENT WILL RESULT IN MY DISQUALIFICATION FROM FURTHER CONSIDERATION OR MY DISMISSAL FROM EMPLOYMENT. I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COOPERATIVE, AND 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 THE COOPERATIVE OR MYSELF. I FURTHER UNDERSTAND THAT NO PERSON IS AUTHORIZED TO MAKE ANY REPRESENTATION CONTRARY TO THE ABOVE STATEMENT UNLESS SUCH REPRESENTATION IS APPROVED BY THE BOARD OF DIRECTORS AND IS EMBODIED IN A WRITTEN AGREEMENT SIGNED BY THE PRESIDENT OR THE GENERAL MANAGER OF THE COOPERATIVE. I FURTHER UNDERSTAND THAT IF OFFERED EMPLOYMENT, I WILL BE REQUIRED TO TAKE A PHYSICAL EXAMINATION AND THAT SUCH EXAMINATION WILL INCLUDE BLOOD, BREATH, URINE, OR SALIVA TESTS TO DETERMINE THE PRESENCE OR USE OF ALCOHOL OR ILLEGAL CONTROLLED SUBSTANCES.

UCEMC is a smoke-free workplace in compliance with the Non-Smoker Protection Act of Tennessee. In accordance with that law and UCEMC policy, smoking is prohibited in enclosed areas of UCEMC property.

Signature Of Applicant

Type Name in Signature Box:

Date: 2025-01-18 14:18:12

Contact

Office Locations
Headquarters
907 N. Main Street
Carthage, TN 37030
1-800-261-2940
E-Mail Contact