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PLC Job Application

If you have any questions, call Human Resources at (253) 853-1353.
To apply, fill out the form below and submit.

*Indicates a required field

Online Application

Name:*
Date of Application:* / /

Address:*
City, State, Zip:*

Home Phone:* ( ) Best time to contact:

Message/Work Phone: May we contact you at work? yes no
Best time to contact:

Email Address:

Position(s) applied for:

Referral Source:
Are you related to anyone employed at PLC? yes no

Are you under 18? yes no
If under 18, do you have a work permit? yes no

Date(s) available for employment:
Preferred Hours: Full-time Part-time Summer Temporary

Are you willing to work:

Weekends?	yes no
Holidays?	yes no
Nights?	yes no

Has notice of termination been given to present employer?

Would it be a problem to bring in your last 2 years of performance evaluations?
yes no

Within the last 7 years, have you been convicted for a felony pertaining to drugs, narcotics, theft, inflicting bodily injury, or any other crime? yes no
If yes, please explain (a conviction record alone will not necessarily bar you from employment):

Were you ever discharged for cause, dismissed during probation, or have you resigned under pressure or unfavorable circumstances? yes no
If yes, please explain (dismissal from prior employment will not necessarily bar you from employment):

Do you have the legal right to remain in the USA? yes no
Are you a Veteran? yes no
If hired, I understand continued employment may depend upon proof of citizenship, alien registration, or work permit.

NOTICE TO APPLICANT

Please read the following and mark below. Application will not be considered if it is not marked.

I understand and agree that any misrepresentation or falsification by me in this application and supporting documents will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed. I understand that this application is not a contract of employment. Furthermore, I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary. I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. I further understand that I may be required to pass a drug/alcohol screen and/or pre-employment physical as a condition of employment. The employer is an equal opportunity employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant’s consideration for employment on a basis prohibited by local, state or federal law.
Please type initials here: to indicate that you have read the above text and certify that all statements in this application are true. **(required)**

This application will be active for 6 months and will be retained for 1 year.
Inquiries regarding compliance with appropriate laws and/or grievance procedures may be directed to the Company’s Human Resources Department. Information may be obtained in an alternate format upon request. Please indicate any accommodation that may be needed. Call (253) 857-1505 for information.

Peninsula Light Company has a drug / alcohol / smoke free environment.

EMPLOYMENT HISTORY

List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in the comments section at the bottom of this section.

Employer:
Address:

Immediate Supervisor and Title:
May we contact for reference?
yes no later

Dates Employed: from to

Hourly Rate/Salary:
Starting: $ per
Final: $ per

Telephone:
( )

Job Title:
Reason for leaving:

Summarize the nature of work performed and job responsibilities:

Employer:
Address:

Immediate Supervisor and Title:
May we contact for reference?
yes no later

Dates Employed: from to

Hourly Rate/Salary:
Starting: $ per
Final: $ per

Telephone:
( )

Job Title:
Reason for leaving:

Summarize the nature of work performed and job responsibilities:

Employer:
Address:

Immediate Supervisor and Title:
May we contact for reference?
yes no later

Dates Employed: from to

Hourly Rate/Salary:
Starting: $ per
Final: $ per

Telephone:
( )

Job Title:
Reason for leaving:

Summarize the nature of work performed and job responsibilities:

Employer:
Address:

Immediate Supervisor and Title:
May we contact for reference?
yes no later

Dates Employed: from to

Hourly Rate/Salary:
Starting: $ per
Final: $ per

Telephone: ( )

Job Title:
Reason for leaving:

Summarize the nature of work performed and job responsibilities:

Comments (including explanation of any gaps in employment):

EDUCATIONAL BACKGROUND

A. List last three (3) schools attended, starting with the last one. B. List number of years completed. C. Indicate degree or diploma earned, if any. D. Grade Point Average or class Rank. E. Major and minor field of study (if applicable).

School	No. Years Completed	Degree Diploma	GPA Class Rank	Major	Minor

List any foreign language(s) and check the box that best describes your skill level.

Language	Read and Write	Read and Speak	Read Only	Speak Only

Professional Licenses/Certifications	Type	State Issued	Number	Expiration Date

REFERENCES

List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Name	Telephone	Years Known
	( )
	( )
	( )

List professional, trade, business or civic associations and any offices held. (Exclude memberships which would reveal sex, race, religion, national origin, age, ancestry or other protected status.)

Organization	Offices Held

List any special accomplishments, publications, awards. (Exclude memberships which would reveal sex, race, religion, national origin, age, ancestry or other protected status.)

List any additional information you would like us to consider.

NOTE: If you experience any difficulties submitting this form, please call Human Resources at (253)853-1353 to confirm that your application has been received. Thank you!

Questions?

Human Resources Office: (253) 853-1353
email:
PLC's Jobline: (253) 857-1531

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