Employment Application

Step 1 of 9 - Personal

Position applied for*
Date of Application*
MM slash DD slash YYYY
PERSONAL
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*

EMPLOYMENT
May we contact your current employer?*
- Yes
- No
Please list at least the last 10 years of employment. List your current or last employer first.
EMPLOYER 1
Name of Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Position
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Salary
Supervisor
Duties
Reason for Leaving
EMPLOYER 2
Name of Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Position
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Salary
Supervisor
Duties
Reason for Leaving
EMPLOYER 3
Name of Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Position
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Salary
Supervisor
Duties
Reason for Leaving
EMPLOYER 4
Name of Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Position
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Salary
Supervisor
Duties
Reason for Leaving
Please explain any gaps in work history
Have you ever been discharged from any employment or asked to resign?*
- Yes
- No
If yes, please explain

PROFESSIONAL REFERENCES
Reference 1
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Relationship
How long known
Reference 2
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Relationship
How long known
Reference 3
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Relationship
How long known

PERSONAL REFERENCES
Reference 1
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Relationship
How long known
Reference 2
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Relationship
How long known
Reference 3
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
How long known
Relationship

NOTIFICATION AND AGREEMENT
Please read before signing. I certify that all answers given by me are true, accurate and complete. I understand that the falsification, misrepresentation or omission of fact on this application (Or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment regardless of when or how discovered. Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed. It is the policy of KPUB to afford equal opportunity to all employees and applicants for employment without regard to age (40 and over), race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, and any other characteristic protected by Federal, State or Local law. If hired, I agree to abide by all of KPUB’s rules and regulations, and understand that, if employed, my employment may be terminated with or without cause and with or without notice, at any time, at the option of either the company or me. I further understand that no representation, whether oral or written by any representative or agent of KPUB, at any time can constitute a contract of employment. I understand that KPUB and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of KPUB has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the General Manager and CEO, or to make any agreement contrary to the foregoing. I understand that KPUB requires the successful completion of a urinalysis for drug testing purposes and/or a blood alcohol test as a condition of employment. I understand I may be required to undergo a post-offer/pre-employment medical examination. By submitting this Application for Employment, I hereby consent to either or both of said tests, and a post-offer/pre-employment medical examination at KPUB’s discretion.*
Please read before signing.

I certify that all answers given by me are true, accurate and complete. I understand that the falsification, misrepresentation or omission of fact on this application (Or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment regardless of when or how discovered.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of KPUB to afford equal opportunity to all employees and applicants for employment without regard to age (40 and over), race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, and any other characteristic protected by Federal, State or Local law.

If hired, I agree to abide by all of KPUB’s rules and regulations, and understand that, if employed, my employment may be terminated with or without cause and with or without notice, at any time, at the option of either the company or me. I further understand that no representation, whether oral or written by any representative or agent of KPUB, at any time can constitute a contract of employment. I understand that KPUB and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of KPUB has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the General Manager and CEO, or to make any agreement contrary to the foregoing.

I understand that KPUB requires the successful completion of a urinalysis for drug testing purposes and/or a blood alcohol test as a condition of employment. I understand I may be required to undergo a post-offer/pre-employment medical examination. By submitting this Application for Employment, I hereby consent to either or both of said tests, and a post-offer/pre-employment medical examination at KPUB’s discretion.
I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.
Legal Name
By providing my legal name, I confirm that I have read, or had read to me, and understand the above and acknowledge and accept the above.

Employment Application

Step 1 of 9 - Personal

PERSONAL

GENERAL INFORMATION

EMPLOYMENT

EMPLOYER 1

EMPLOYER 2

EMPLOYER 3

EMPLOYER 4

EDUCATION

High School Information

College Information

Graduate School Information

Business, Trade, Technical or Other School School Information

ADDITIONAL EXPERIENCE OR QUALIFICATIONS

ATTENDANCE AND PUNCTUALITY INFORMATION

PROFESSIONAL REFERENCES

Reference 1

Reference 2

Reference 3

PERSONAL REFERENCES

Reference 1

Reference 2

Reference 3

Equal Opportunity Employment

NOTIFICATION AND AGREEMENT

Office Location

Outages

Hours of Operation

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