Step 1 of 6 0% This application will be considered active for a period of 1 year and thereafter retires to an inactive file. You may renew this application by filing a new form. The following information is requested in order to help us make the best possible placement within the Cooperative and select the best qualified applicant. All portions of this application pertaining to you must be completed. The Cooperative, in accordance with State and Federal laws, does not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age (40 or older), disability and genetic information (including family medical history), or veteran status. The Cooperative also is 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. We appreciate the time you spend in filling in this application.Personal InformationResume UploadMax. file size: 300 MB.Name(Required) First Last Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email (to receive a copy of your application submission)(Required) Are You Legally Eligible to Work in the United States?(Required)(Proof of identity and eligibility will be required upon employment) Yes No Are You Related, By Blood or Marriage, to Any Existing Employee or Board Member of the Cooperative?(Required) Yes No Please State Name and Relationship Do you have a valid driver's license?(Required) Yes No Have You Ever Applied for a Job with the Cooperative?(Required) Yes No When? Have You Ever Worked at the Cooperative Before?(Required) Yes No When and Where? Position Applying For(Required)(Be specific) Salary Expected(Required) When are You Available to Start Work? (mm/dd/yyyy)(Required) Month Day Year Can You Work Overtime Including Weekends?(Required) Yes No Are You Available For After-Hours Call-Out Duty and On-Call Assignment?(Required) Yes No Are You at Least 18 Years of Age?(Required) Yes No Have You Ever Been Convicted of a Felony?(Required) Yes No Give Details Including Jurisdiction (State and County) Where Such Conviction Occurred(A conviction record will not necessarily be a bar to employment but will be considered in relation to specific job requirements.)Have You Ever Been Convicted of a Power (Electricity) Theft or Power Diversion?(Required) Yes No Give Details Including Jurisdiction (State and County) Where Such Conviction OccurredAre You Able to Perform the Essential Job Functions of the Position for Which You Are Applying?(Required) Yes No Please Indicate What Special Accommodations Would Need to Be Provided for You to Do So EducationHigh School(Please list School Name, Address (City/State), Number of Years Attended, Degree, and Major) Technical School(Please list School Name, Address (City/State), Number of Years Attended, Degree, and Major) Other(Please list School Name, Address (City/State), Number of Years Attended, Degree, and Major) Personal ReferencesPersonal References (Not Former Employees or Relatives)(Required)Name and OccupationRelationship to ApplicantEmail/Phone Number Add Remove Employment RecordName of Employer Starting Date (mm/dd/yyyy) Month Day Year Ending Date (mm/dd/yyyy) Month Day Year Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneSupervisor Name May We Contact? Yes No Job Title Starting SalaryEnding SalaryDescription of DutiesReason for Leaving Add another employer? Yes No Name of Employer Starting Date (mm/dd/yyyy) Month Day Year Ending Date (mm/dd/yyyy) Month Day Year Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneSupervisor Name May We Contact? Yes No Job Title Starting SalaryEnding SalaryDescription of DutiesReason for Leaving Add another employer? Yes No Name of Employer Starting Date (mm/dd/yyyy) Month Day Year Ending Date (mm/dd/yyyy) Month Day Year Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneSupervisor Name May We Contact? Yes No Job Title Starting SalaryEnding SalaryDescription of DutiesReason for Leaving Add another employer? Yes No Name of Employer Starting Date (mm/dd/yyyy) Month Day Year Ending Date (mm/dd/yyyy) Month Day Year Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneSupervisor Name May We Contact? Yes No Job Title Starting SalaryEnding SalaryDescription of DutiesReason for Leaving Certification(Required) I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Shenandoah Valley Electric Cooperative to hire me. If I am hired, I understand that either Shenandoah Valley Electric Cooperative or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Shenandoah Valley Electric Cooperative has the authority to make any assurance to the contrary.I attest with my signature that I have given to Shenandoah Valley Electric Cooperative true and complete information on this application. No requested information has been concealed. I authorize Shenandoah Valley Electric Cooperative to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.Applicant Electronic Signature (Full Name)(Required) Affirmative Action: Applicant Invitation to Self-Identify: Veteran, Gender and Race (VEVRAA & EO 11246) Shenandoah Valley Electric Cooperative is an equal opportunity employer. As required by law, we must record certain information to be made a part of our affirmative action program. Applicants for employment are invited to participate in the affirmative action program by reporting their status as a protected veteran or other minority. In extending this invitation, we advise you that: (a) workers (applicants) are under no obligation to respond but may do so in the future if they choose; (b) responses will remain confidential within the human resource department; and (c) responses will be used only for the necessary information to include in our affirmative action program. We are a company that values diversity. We actively encourage women, minorities, veterans and disabled employees to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.Name First Last Position Applied For Date Completed MM slash DD slash YYYY Gender Male Female Prefer Not to Answer Race or Ethnicity Hispanic or Latino White (not Hispanic or Latino) Black or African American (not Hispanic or Latino) Native American or Pacific Islander (not Hispanic or Latino) Asian (not Hispanic or Latino) American Indian or Alaskan Native (not Hispanic or Latino) Two or more races (not Hispanic or Latino) Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East or North Africa. Black or African American (not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands. Asian (not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam American Indian or Alaska Native (not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America) and who maintain tribal affiliation or community attachment. Two or more races (not Hispanic or Latino) - All persons who identify with more than one of the above races.Veteran Status I am a protected veteran I am NOT a protected veteran I do not wish to self-identify How did you hear of our opening? Employee referral Company website Job board Social Media Advertisement (print/radio/tv) Recruiter Other THIS IS A DATA COLLECTION SHEET AND WILL BE REMOVED BEFORE THE APPLICATION IS REVIEWED Voluntary Self-Identification of Disability Form CC-305, OMB Control Number 1250-0005 Expires 04/30/2026Name First Last Employee ID (if applicable) Today's Date MM slash DD slash YYYY Why are you being asked to complete this form? We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years. Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. How do you know if you have a disability? A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to: Alcohol or other substance use disorder (not currently using drugs illegally) Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS Blind or low vision Cancer (past or present) Cardiovascular or heart disease Celiac disease Cerebral palsy Deaf or serious difficulty hearing Diabetes Disfigurement, for example, disfigurement caused by burns, wounds, accidents or congenital disorders Epilepsy or other seizure disorder Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome Intellectual or developmental disability Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD Missing limbs or partially missing limbs Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports Nervous system condition, for example, migraine headaches, Parkinson’s disease, Multiple sclerosis (MS) Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities Partial or complete paralysis (any cause) Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema Short stature (dwarfism) Traumatic brain injury Please check one of the boxes below: Yes, I have a disability, or have had one in the past No, I do not have a disability and have not had one in the past I do not want to answer PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.NameThis field is for validation purposes and should be left unchanged.
