Career Application Form for Corn Belt Power Cooperative

Personal Information

First Name*

M.I.*

Last Name*

Preferred First Name

Address 1*

Address 2

City*

State*

Zip*

Email Address*

Home Phone*

Business/Cell Phone*

Position for which you are applying*

Expected Salary*

Are you interested in:

Full-Time employment*

Part-Time employment

If accepted, when can you start?*

Education

If your school records are under a different name(s), please enter that name(s):

High School

Name*

City/State

Graduate?*

Yes

College

Name

City/State

Highest Year Completed

Did you graduate?

Yes

List Diploma or Degree:

Major Subject:

Minor Subject:

+ Add Additional College Education - Remove College

Are you attending school or taking courses now?*

Yes

If yes, where?

Work Experience

(List below all present and past employment, beginning with your most recent, including military service.)

Job

Name of Company*

Type of Business*

Address*

City*

State*

Zip*

Telephone No.:*

Supervisor:*

From*

To*

Starting Salary:

Last Salary:

Reason for Leaving*

Describe the Work you did:

+ Add Additional Work Experience - Remove Work Experience

List machines (type and model) you can operate:

List special qualifications or skills

Licenses and Certifications

(Include State Driver’s License and Commercial Driver’s License)

Type:

Issued By:

Date:

Number:

+ Add Additional License/Certification - Remove License/Certification

Reference Information

(List references, i.e. supervisors, instructors, etc. No Relatives)

Reference 1

Name:*

Occupation:*

Address:*

Phone*

Email*

Reference 2

Name:*

Occupation:*

Address:*

Phone*

Email*

Reference 3

Name:*

Occupation:*

Address:*

Phone*

Email*

Upload your Resume File:

(200k file size limit) (Only PDF, MS Word, TXT files accepted)

Signature*

Read Carefully:

Corn Belt Power Cooperative is an employment-at-will employer.

I certify that the facts contained in this application are true and complete. I understand that falsified statements on this application shall be considered cause for discharge.

I understand that any offer of employment made by Corn Belt Power Cooperative is contingent upon the satisfactory results of a medical examination and a drug screen. I also acknowledge that the employer may require drug testing at a subsequent time, provided that proper advance notice of testing is provided.

I agree to conform to the rules, regulations and policies of the Cooperative and acknowledge that these rules, regulations, policies and other terms and conditions, including benefits, may be changed by the Cooperative at any time and without prior notice to me. Where the policies of the Cooperative conflict with the collective bargaining union contract, the union contract prevails.

No representative or employee of the Cooperative, with the exception of the Executive Vice President & General Manager, has the authority to enter into any contract or agreement to the contrary, and then only if such commitment is in a written document signed by the Executive Vice President & General Manager and the employee.

Accordingly, I agree to submit to a medical physical examination to determine if I am qualified to perform the essential functions of the job, if requested.

BOTH THE UNDERSIGNED AND CORN BELT POWER COOPERATIVE MAY END THE EMPLOYMENT RELATIONSHIP AT ANY TIME, WITHOUT SPECIFIED NOTICE OR REASON, AND WITHOUT LIABILITY BY CORN BELT POWER COOPERATIVE TO THE UNDERSIGNED EXCEPT FOR EARNED WAGES OR SALARY.

This application will be maintained in the Cooperative’s active files for 12 months only, unless renewed.

I acknowledge that I have read and understand these terms.*

Name:

Date:*

IMPORTANT: By printing your full name above you release and agree that your full printed name is an equivalent of and a replacement for your handwritten signature, and that you certify that you understand all the questions and statements in this form just as if you had signed this application.

Power Plant Control Operator

High School

College

Job

Licenses and Certifications

Reference 1

Reference 2

Reference 3

Upload your Resume File: