Application For Employment

Personal Information

First name *

Last name *

Address *

State *

City *

ZIP Code *

Phone Number *

Email Address *

Employment Desired

Position *

Start Date *

Desired Salary *

Are you currently employed? *

Yes

No

May we contact your present employer? *

Yes

No

Are you related to anyone in our company or a Mayfield, KY city official? *

Yes

No

If yes, who & how related?

Education

High School

School Name *

School Location *

Years Attended *

Date Graduated *

Subjects Studied *

College

College Name

College Location

Years Attended

Date Graduated

Subjects Studied

Trade or Business School

School Name

School Location

Years Attended

Date Graduated

Subjects Studied

**List office machines/construction equipment you can operate

Former Employers

(List below the last three (3) employers, starting with the most current)

Employer 1

Employer Name

Employer Location

Start Date

End Date

Job Title

Salary

Reason for Leaving

Employer 2

Employer Name

Employer Location

Start Date

End Date

Job Title

Salary

Reason for Leaving

Employer 3

Employer Name

Employer Location

Start Date

End Date

Job Title

Salary

Reason for Leaving

References

(List below the names of three (3) persons whom you have known at least one year)

Reference 1

Name

Business

Address

Phone

Years Acquainted

Reference 2

Name

Business

Address

Phone

Years Acquainted

Reference 3

Name

Business

Address

Phone

Years Acquainted

I authorize investigation of all statements contained in this application. I understand the misrepresentation or omission of facts called for is cause for dismissal. I further authorize investigation of my character, general reputation, personal characteristics and mode of living. I understand my right under the Fair Credit Reporting Act to request disclosures of the nature and scope of any such investigation. *

I agree

Mayfield Electric & Water Systems is governed by the provision of KRS 96.740. In accordance with KRS 96.740(3), any person who is related within the third degree to any member of the Electric Board, the Mayor of the City of Mayfield, or any member of the Mayfield City Council shall not be eligible for employment by Mayfield Electric & Water Systems.

I understand the provision of KRS 96.740(3) and hereby certify that I am not related within the third degree to any member of the Electric Plant Board, the Mayor of the City of Mayfield, or any member of the Mayfield City Council. *

I understand