Employment Application

Personal Information

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address(Required)

Phone(Required)

Are you legally authorized to work in the United States?

Yes

Do you now, or will you in the future, require immigration sponsorship for work authorization (e.g., H-1B)?

Yes

Is the Applicant related to a current Board member of Tri-County Communications Cooperative?

Yes

Bylaws of the Cooperative prohibit certain employees from receiving compensation if related to a Board member. By submitting this application, the applicant understands that if they are offered and accept employment and a close relative* is elected to the Board of Directors, your employment with the Cooperative could be terminated pursuant to the Bylaws. (*Close relative includes grandparents, parents, spouse, children, grandchildren, siblings, uncles, aunts, nephews, and nieces, by blood, by marriage, or by adoption, and spouses of any of the foregoing.)

Employment Desired

Position

Date you can start

Salary desired

Are you currently employed?

Yes

May we contact your employer?

Yes

Have you ever applied to TCC before?

Yes

If so, when?

Education

High school name and location

Graduated?

Yes

Emphasis

GPA

College name and location

Graduated?

Yes

Emphasis

GPA

Other (specify) school name and location

Graduated?

Yes

Emphasis

GPA

Any additional training, skills, or experience you'd like to mention?

Former Employers

List your last four employers starting with most recent. Please include start/end date, name, address, salary, position, and reason for leaving

References

Give the names of three persons not related to you, whom you have known for at least one year.

Name of first reference

First Last

Address

Business

Years acquainted

Name of second reference

First Last

Address

Business

Years acquainted

Name of third reference

First Last

Address

Business

Years acquainted

General

In case of emergency, notify

First Last

Phone

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that any employment accepted by me shall be “at will” employment, and such employment may be terminated at any time without cause. I understand that this application will be kept on file for one (1) year from the date of signature.

Signed

Date signed

Resume

Max. file size: 50 MB.

Cover letter

Max. file size: 50 MB.