Office: 903.994.4200
Fax: 903.994.2747

3163 FM 499
P.O. Box 557
Cumby, TX 75433

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APPLICATION FOR EMPLOYMENT

TO PROTECT PERSONAL INFORMATION THE CONTENTS OF THIS FORM WILL BE TRANSMITTED SECURELY

Employment Application

All information is transmitted securely. Fields marked * are required.

Step 1 of 5 Personal Information

Personal Information

Employment Desired

Former Employers

Education

Emergency Contact & Authorization

Personal Information

Date *

Social Security Number *

Last Name *

First Name *

Middle Name

Present Address *

City *

State *

Zip *

Mailing Address

City

State

Zip

Phone Number *

Cell Phone

Driver's License #

State

Referred By

Do you have a CDL? *

Yes No

Employment Desired

Position *

Date Available *

Salary Desired

Are you employed now? *

Yes No

If yes, may we contact your present employer?

Yes No

Have you ever worked for this company before? *

Yes No

If yes, when?

Do you have any relatives or friends working for this company? *

Yes No

If yes, who?

Former Employers

List all former employers for the last 10 years. Please list your most current employer first. You may add up to 10.

Education

High School

Last Year Completed

1 2 3 4

Graduate?

Yes No

College

Last Year Completed

1 2 3 4

Graduate?

Yes No

Trade/Business School

Last Year Completed

1 2 3 4

Graduate?

Yes No

Please list any job related skills

Emergency Contact & Authorization

In case of emergency, notify *

Relationship *

Phone Number *

Address

I authorize investigation on all statements in this application. I understand that misrepresentation of information requested is cause for dismissal. Further, I understand, and agree, that my employment is for no definite period, and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice. I furthermore certify that all dates, times, and names are true to the best of my knowledge.

I authorize investigation on all statements in this application *

Yes No

Date *

Review & Submit

Please review your information before submitting.

Application Submitted

NORTHEAST TEXAS POWER, LTD | 3163 FM 499 | POB 557 Cumby TX 75433 | Office 903.994.4200 Fax 903.994.2747