LinPepCo Application for Employment

This document is our chief source of information for initial employment consideration. Therefore, it is necessary that you clearly and completely state your skills, knowledge, and abilities as they relate to the position for which you are applying. It is also important that your employment history is accurate, complete and detailed. Add any job-related information you feel may be helpful. This application will remain active for a period of 90 days from the date of application. Thank you for your interest in LinPepCo!

LinPepCo is an equal opportunity employer, dedicated to a policy prohibiting discrimination in employment on the basis of race, religion, color, national origin, age, sex, gender, disability, genetic information, or any other characteristic protected by federal, state, or local law.

Personal Information

Date of Application (MM/DD/YYYY) *

Location Applying For: *

Last Name *

First *

M.I.

Street Address *

Apt/Unit #

City *

State: *

ZIP *

Phone (##########) *

Email Address *

Date Available (MM/DD/YYYY) *

Desired Salary (0.00)

Available to Work *

Driver's License Held: *

Regular Drivers License

CDL-A

CDL-B

None - Do not drive

Position/Type of Position Applying For in Lincoln: *

Position/Type of Position Applying For in South Sioux City: *

Position/Type of Position Applying For in Topeka: *

Position/Type of Position Applying For in Alliance: *

Position/Type of Position Applying For in Sidney: *

Position/Type of Position Applying For in Valentine: *

Position/Type of Position Applying For in Hastings: *

Where did you learn of the job? *

Referring Name or Source *

General Information

Are you legally authorized to work in the U.S.? *

Yes

No

Have you ever been employed with us before? *

Yes

No

If yes, what date? From:

To:

Education

If no education, enter "NONE" under Name

	Name	Location and Telephone	Course	Graduate (Yes or No)	Degree
High School/GED	Name	Location and Telephone	Course	Graduate (Yes or No)	Degree
College	Name	Location and Telephone	Course	Graduate (Yes or No)	Degree
Post Graduate	Name	Location and Telephone	Course	Graduate (Yes or No)	Degree

Training and Skills

Job-related Training/Experience Acquired Through Prior Employment, Military Service, or Other:

Work Experience (Most Recent)

Name of Employer

Address of Employer

Start Date

End Date

Telephone of Employer (##########)

Supervisor's Name and Title

Beginning Salary:

Ending Salary: *

Position or Title

Description of Duties

Reason for Leaving: *

May we contact for a reference

Yes

No

Next Previous Employer

Name of Employer

Address of Employer

Start Date

End Date

Telephone of Employer (##########)

Supervisor's Name and Title

Beginning Salary:

Ending Salary: *

Position or Title

Description of Duties

Reason for Leaving:

May we contact for a reference?

Yes

No

Next Previous Employer

Name of Employer

Address of Employer

Start Date

End Date

Telephone of Employer (##########)

Supervisor's Name and Title

Beginning Salary:

Ending Salary: *

Position or Title

Description of Duties

Reason for Leaving:

May we contact for a reference

Yes

No

Next Previous Employer

Name of Employer

Address of Employer

Start Date

End Date

Telephone of Employer (##########)

Supervisor's Name and Title

Beginning Salary:

Ending Salary: *

Position or Title

Description of Duties

Reason for Leaving:

May we contact for a reference?

Yes

No

Additional Comments

Please provide any additional information you feel is relevant to your Application for Employment.

Business References

If no business references, enter "NONE" under Name.

Name

Company

Address

Telephone Number (##########)

Name

Company

Address

Telephone Number (##########)

Name

Company

Address

Telephone Number (##########)

Name

Company

Address

Telephone Number (##########)