GreyStone Power Corporation

GreyStone Power Application for Employment

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications. All positions require a background check, drug screening and a physical. A credit investigation is necessary for positions that require bonding. It is our policy to accept applications for employment for existing vacancies only. A separate application must be submitted for each job application.

To help GreyStone Power Corporation comply with Federal/State equal employment opportunity record keeping, reporting and other legal requirements, please answer the questions below. All applicants are considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.

If you require more than one session to complete this form, you can save your data ON THIS COMPUTER and complete the form later. Click the 'Save my data' button at the bottom of the paqe.

*Position applying for:

Referred by:

Applicant Profile:

*First Name:
*Last Name:
*Current Address:
*City:
*State:
*Zip Code:

*Primary Phone Number:
Secondary Phone Number:
Email address:
*Social Security Number:
Provide your date of birth ONLY if you are younger than eighteen years of age.
Date of Birth:	(MM/DD/YYYY)
Resume:

Previous Address (List all for past 3 years)

Previous Address

Address, City, State, Zip Code:

From (Month/Year):
To (Month/Year):

Previous Address

Address, City, State, Zip Code:

From (Month/Year):
To (Month/Year):

Previous Address

Address, City, State, Zip Code:

From (Month/Year):
To (Month/Year):

Previous Address

Address, City, State, Zip Code:

From (Month/Year):
To (Month/Year):

Background Information

*Are you a U. S. Citizen?:
*Were you ever convicted of a felony?:
If yes, indicate the nature of the offense and the date of occurrence.:

Were you in the U.S. Armed Forces?:
List any training you received that would aid you in performing the job for which you applied.:

Do you require special accommodations for completing the application process?
*Require special accomodations?:
If you require special accommodations, explain below or you can contact us at 770-370-2980.:

Job Related Information:

What is your salary expectation:
Are you available to work Full-time?:
If you are not available Full-time, specify days and hours available below:
Days and Hours Available:
On what date will you be available to start work?
Start date:	(MM/DD/YYYY)
Due to the nature of furnishing electrical power to our members, overtime work in addition to a regularly scheduled workday may be required. Are you willing to work overtime and/or an alternate schedule?
*Will you work overtime?:
If you can't work overtime, explain below:

If the position requires you to drive a company vehicle, do you have a valid driver's license?
Valid Driver's license?:
Type of license:
Do you have any relatives (by blood or marriage) working for GreyStone Power, related to one of the Board of Directors, or the Attorney of GreyStone Power?
*Relatives at Greystone Power?:
If yes, please give his/her name and relationship.
Relative Name/Relationship:
Were you previously employed by us?
Employed by GreyStone?:
If yes, when were you employed?:
Were you previously employed by another electric cooperative?
Employed by a cooperative?:
If yes, at which cooperative were you employed?
Cooperative employed by:

ADDITIONAL REFERENCES Please provide business references.
For each reference provide Name, Phone Number and Relationship.

Reference 1:

Reference 2:

Reference 3:

High School:

*Name and Address of School:

Did You Graduate?:
If yes, Diploma or GED?:

Secondary Education:

(Including Technical, Trade, Community College and University)

Name and Address of School:

Date From (Month/Year):
DateTo (Month/Year):
Course of Study:
Date Graduated (Month/Year):
Type of Degree Received:
GPA:
Major and Minor Field of Study:

Name and Address of School:

Date From (Month/Year):
DateTo (Month/Year):
Course of Study:
Date Graduated (Month/Year):
Type of Degree Received:
GPA:
Major and Minor Field of Study:

Name and Address of School:

Date From (Month/Year):
DateTo (Month/Year):
Course of Study:
Date Graduated (Month/Year):
Type of Degree Received:
GPA:
Major and Minor Field of Study:

Name and Address of School:

Date From (Month/Year):
DateTo (Month/Year):
Course of Study:
Date Graduated (Month/Year):
Type of Degree Received:
GPA:
Major and Minor Field of Study:

List special courses or certifications taken that are relevant to the job applied for:

Are there any other experiences, skills, or qualifications we should consider?:

EMPLOYMENT HISTORY

List employers for the last 10 years in reverse order starting with the most recent. List complete mailing address, street number, city, state, and ZIP Code. Complete even if a resume is attached.

Employer 1:

Name and Full Address:

Contact Person:
Contact Number:
From (Month/Year):
To (Month/Year):
Position Held:
Salary:
Reason for leaving:

Employer 2:

Name and Full Address:

Contact Person:
Contact Number:
From (Month/Year):
To (Month/Year):
Position Held:
Salary:
Reason for leaving:

Employer 3:

Name and Full Address:

Contact Person:
Contact Number:
From (Month/Year):
To (Month/Year):
Position Held:
Salary:
Reason for leaving:

Employer 4:

Name and Full Address:

Contact Person:
Contact Number:
From (Month/Year):
To (Month/Year):
Position Held:
Salary:
Reason for leaving:

Employer 5:

Name and Full Address:

Contact Person:
Contact Number:
From (Month/Year):
To (Month/Year):
Position Held:
Salary:
Reason for leaving:

Employer 6:

Name and Full Address:

Contact Person:
Contact Number:
From (Month/Year):
To (Month/Year):
Position Held:
Salary:
Reason for leaving:

Employer 7:

Name and Full Address:

Contact Person:
Contact Number:
From (Month/Year):
To (Month/Year):
Position Held:
Salary:
Reason for leaving:

Employer 8:

Name and Full Address:

Contact Person:
Contact Number:
From (Month/Year):
To (Month/Year):
Position Held:
Salary:
Reason for leaving:

Employer 9:

Name and Full Address:

Contact Person:
Contact Number:
From (Month/Year):
To (Month/Year):
Position Held:
Salary:
Reason for leaving:

Employer 10:

Name and Full Address:

Contact Person:
Contact Number:
From (Month/Year):
To (Month/Year):
Position Held:
Salary:
Reason for leaving:

PLEASE READ AND SIGN BELOW

I certify that answers in my application for employment are true and complete to the best of my knowledge. I understand that if employed, false statements on this application shall be considered sufficient cause for immediate dismissal. You are hereby authorized to make any investigation of my personal history, financial and credit record through any investigative or credit agencies or bureaus of your choice, if such financial and credit record is necessary due to bonding.

I authorize you to make an investigative report whereby information is obtained regarding my past employment ability, education, and character. I understand that I have the right to make a written request within a reasonable period of time to receive information about the nature and scope of such investigative report that is made.

I agree to conform to the Rules and Regulations of GreyStone Power Corporation and to follow all health and safety regulations, including the use of safety equipment at all times on the job.

I understand that test results demonstrating the presence of un-prescribed drugs, controlled substances or alcohol will result in no offer of employment and if employed, positive results of subsequent drug screens could result in termination.

I understand that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the employer of myself.

I understand that prior to or after employment, any misrepresentations, omissions of facts or incomplete information requested in this application may remove me from further consideration or dismissal from employment.

Investigation Consent

I understand and acknowledge that an investigative consumer report may be obtained for employment purposes.

I authorize the company I have made application with, or its designated agent, to conduct pre- employment or other business, governmental agency or individual contacted to supply the requested information and documents concerning me and to provide full and complete disclosure. I understand that all pre-employment screening activities are conducted in compliance with EEOC, VEVRAA, Section 503 of the Rehabilitation Act, and the Fair Credit Reporting Act (FCRA) requirements.

I release from liability the company I have made application with, and its representatives for gathering and using such information. I fully release the person or entity providing the information of any right or claim of confidentiality concerning disclosure of the information requested below or any and all claims, actions, or causes of action which may arise as a consequence of the release of such information as may be requested concerning: (1) Completed background reference and work history checks: (2) Criminal and civil litigation history information or any other public records (such as driving records, liens, judgments, and sex offender status); (3) Credit reports, academic achievement, professional licensure, bankruptcy filings; (4) Previous incidents of alleged sexual or racial harassment; (5) Precious incidents of violent behavior and/or suspected dishonest acts; (6) Results of previous drug testing within the past two years if positive for illegal substances; (7) Eligibility for rehire and circumstances of previous separation from employment; (8) Social Security Number verification; and (9) Information concerning any or all worker's compensation claims if a conditional offer of employment has been made.

I request that any law enforcement agency, institution, information service bureau, school, employer, reference, or insurance company contacted pursuant to this investigation consent form cooperate fully and completely in responding to the inquiries. By my signature below, I acknowledge that I have received a Summary of my Rights under the Fair Credit Reporting Act (FCRA).

Drug Testing Consent

GreyStone conducts random drug screens throughout the year and employment is conditioned upon the results of a pre-employment physical and drug screen by a certified physician.

*Are you willing to take these tests?:

Click here to draw your signature.

Signature of Applicant

With your mouse, draw your signature. Then click Finish.

Signature Date:

(MM/DD/YYYY)

Voluntary Equal Employment Opportunity Questionnaire
Applicants and employees are treated without regard to race, color, religion, sexual orientation, gender, national origin, citizenship status (unless required by a government contract), age, marital or veteran status, physical or mental disability, or any other legally protected status during every aspect of the employment process.

As employers and government contractors, we comply with all government regulations including but not limited to equal opportunity and affirmative action responsibilities. Solely to help us comply with affirmative action record keeping, reporting and other legal requirements, please complete the survey below. This information will not be used for hiring, placement, or other decisions related to the terms and conditions of employment. This document will be kept in a confidential file, separate from applicant and personnel files. When reported, data will not identify any specific individual.

YOUR COOPERATION IS VOLUNTARY.

INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.

Definitions: Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.

White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Disabled Individual - A person who (1) has a physical or mental impairment that substantially limits one or more major life activities, and (2)has a record of such impairment or is regarded as having such an impairment.

Veteran of the Vietnam Era - A person who served on active duty for a period of more than 180 days (A) between August 5, 1964 and May7, 1975, or (B) in the Republic of Vietnam between February 28, 1961 and May 7, 1975 and (1) was discharged or released with other than a dishonorable discharge, or (2) was discharged or released from active duty because of a service-connected disability during this period.

Special Disabled Veteran - A person who (1) was discharged or released from active duty due to a service-connected disability, or (2) is entitled to disability compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Veterans Administration for a disability rated at 30 percent or more or at 10 or 20 percent if the veteran has been determined to have a serious employment handicap.

Other Protected Veteran - Any other veteran who served on active duty in the U.S. military ground, naval, or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, other than a special disabled veteran, veteran of the Vietnam era, or recently separated veteran.

If you do not wish to provide this information, you may select "Opt Out" or "Do not wish to disclose" from the drop-downs below. If you are a Protected Veteran and do not wish to self-identify the classification to which you belong then select the option "I'm a protected veteran, but choose not to specify".

*Are you Hispanic or Latino?:
*What is your Ethnic Origin?:
*What is your Gender?:
*Are you a Disabled Veteran?:
*Are you Special Disabled Veteran?:
*Are you a Recently Separated Veteran?:
*Active Duty Wartime or Campaign Veteran?:
*Armed Forces Service Medal Veteran?:

Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017 Page 1 of 1

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:
Blindness
Deafness
Cancer
Diabetes
Epilepsy
Autism
Cerebral palsy
HIV/AIDS
Schizoprenia
Muscular distrophy
Bipolar disorder
Major depression
Multiple sclerosis (MS)
Missing limbs or partially missing limbs
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Intellectual disability (previously called mental retardation)

*Do You Have a Disability?:

Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to do your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

(i). Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.