Utility Application
Please fill in your details.
Personal Information
First name
Last name
Address
Email
Phone Number
Tell us about yourself.
Date of Birth
Gender
Male
Female
Who Referred You?
Employment Desired:
Full-Time
Part-Time
Seasonal
Employment Eligibility
Are you legally eligible to work in the U.S.?
YES
NO
Have you ever worked for this employer?
YES
NO
If yes, write the start and end dates:
Have you ever been convicted of a felony
YES
NO
If yes, please provide explanation. Failure to disclose the type of felony and explanation will result in applciation rejection.
Ethnicity and Race Identification
Specific Instructions: (For EEO compliance reporting purposes.) The two questions below are designed to identify your ethnicity and race. Regardless of your answer to question 1, go to questions 2.
Question 1: Are you Hispanic or Latino?
YES
NO
Please select the racial category or categories with which you most closely identify by placing an "X" in the appropriate box. Check as many as apply.
Black / African American
American Indian / Alaskan Native
Asian
Pacific Islander
Hispanic / Latino
White
Two or more races
Not Specified
Military Service
Are you a Veteran
YES
NO
Branch
Rank At Discharge
From:
To
Type of Discharge
If not honorable, please explain:
Background Check Consent
If asked, are you willing to consent to a background check?
YES
NO
Upload Resume (Optional)
Select a File
Disclaimer
Applicant understand that this is an Equal Opportunity Employer and is committed to excellence through diversity. To ensure this application is acceptable, please type complete the application in its entirety to be considered. Please complete each section EVEN IF you decide to attach a resume. I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment. I understand that any false or misleading information in my application or interview may result in my employment being terminated.
I understand
Signature
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Date
Type Full Name
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