Job Application

An Equal Opportunity Employer

This application will be considered active and retained on file for a period of one (1) year. Salt River Electric Cooperative Corporation, in
accordance with State and Federal laws, does not discriminate on the basis of race, color, disability, religion, age, sex, sexual orientation,
gender identity, citizenship, marital status, veteran status, or national origin. The Cooperative also is required by law, by virtue of its
contract(s) with the federal government, to take affirmative action to employ individuals with disabilities and protected veterans.

Personal Information

Name
Name
First Name
Last Name
Address
Address
City
State/Province
Zip/Postal
Country
Are you a US Citizen or a Permanent Resident Alien?
Do you have a legal right to work in the United States?
Are you at least 18 years of age?
Do you have a valid driver’s license?
Do you fluently speak a second language, such as Spanish?
Have you ever been convicted of a felony?
Are you related, by blood or marriage, to any existing employee of Salt River Electric or a Salt River Electric Director?

Desired Position

Are you able to perform the essential functions of the position as described in the job description?
Have you previously been employed by Salt River Electric or another electric cooperative?
Are you able to work overtime?
Are you available for after-hours assignments?

Education and Skills

Please indicate your most recent level of education completed.
High School
College/University
Vocational School
Skills

Employment History

Address
Address
City
State/Province
Zip/Postal
Country
Address
Address
City
State/Province
Zip/Postal
Country
Address
Address
City
State/Province
Zip/Postal
Country

Personal References

Name
Name
First Name
Last Name
Address
Address
City
State/Province
Zip/Postal
Country
Name
Name
First Name
Last Name
Address
Address
City
State/Province
Zip/Postal
Country
Name
Name
First Name
Last Name
Address
Address
City
State/Province
Zip/Postal
Country

Certification & Authorization

I hereby affirm that the information provided on this application is true and complete to the best of my knowledge and agree that falsified information or significant omissions may disqualify me from further consideration and may be considered justification for dismissal, even if disclosed at a later date. I authorize person, schools, current employers, (if applicable), previous employers and organizations named in this application to provide Salt River Electric with any relevant information that may be required to arrive at an employment decision. In consideration of my employment, I agree to conform to the rules and regulations of the Cooperative and that my employment and compensation can be terminated, with or without notice, at any given time, at the option of wither the Cooperative or myself. I understand that no representative of the Cooperative, other than the president, has any authority to enter into agreement for employment for any specified period of time or to make any agreement contrary to the foregoing.
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APPLICANT INFORMATION FORM



Applicant Information Form


Applicant Information Form

Note: In order for us to meet federal record-keeping requirements, we request that you answer the following personal questions. This information is
voluntary, and refusal to provide it will not result in any adverse treatment. This information will not be used for any purpose in the employee selection
process. if you have any questions about this questionnaire, please do not hesitate to ask to speak to our Human Resources Department.

Name
Name
First Name
Last Name
Race (Choose one):


Voluntary Self-Identification of Disability


Voluntary Self-Identification of Disability

Form CC-305 | OMB Control Number 1250-0005 | Expires 04/30/2026

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities.
We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress toward this goal.
To do this, we must ask applicants and employees if they have a disability or have ever had one.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential.
No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way.
If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at
www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.”
If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

  • Alcohol or other substance use disorder (not currently using illegally)
  • Autoimmune disorders (e.g., lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS)
  • Blind or low vision
  • Cancer (past or present)
  • Cardiovascular or heart disease
  • Celiac disease
  • Cerebral palsy
  • Deaf or serious difficulty hearing
  • Diabetes
  • Disfigurement (e.g., burns, wounds, congenital conditions)
  • Epilepsy or other seizure disorder
  • Gastrointestinal disorders (e.g., Crohn’s disease, IBS)
  • Intellectual or developmental disability
  • Mental health conditions (e.g., depression, bipolar, PTSD)
  • Missing limbs or partially missing limbs
  • Mobility impairment (e.g., wheelchair, leg brace)
  • Nervous system conditions (e.g., migraines, Parkinson’s, MS)
  • Neurodivergence (e.g., ADHD, autism, dyslexia)
  • Partial or complete paralysis
  • Pulmonary or respiratory conditions (e.g., asthma, emphysema)
  • Short stature (dwarfism)
  • Traumatic brain injury

Public Burden Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless it displays a valid OMB control number. This survey should take about 5 minutes to complete.

Voluntary Self Identification Form Disabled and Protected Veteran Status

Voluntary Self-Identification Form

Disabled and Protected Veteran Status

Salt River Electric is an equal opportunity employer and in accordance with State and Federal laws, does not discriminate on the basis of race, color,
disability, religion, age, sex, sexual orientation, gender identity, citizenship, marital status, veteran status, or national origin. The Cooperative also is
required by law, by virtue of its contract(s) with the federal government, to take affirmative action to employ individuals with disabilities and protected
veterans.

In order to fulfill our reporting obligations, we request your voluntary completion of the information below. Failure to complete this form will
have no bearing on the processing or status of your application and will in no way impact your consideration for employment with Salt River Electric.
The information will not be maintained with your application, or if hired, your personnel file.

Name
Name
First Name
Last Name
Are you a United States Citizen?
Do you have citizenship in any other country?
Disabled Veteran
Recently Separated Veteran
Armed Force Service Medal Veteran
Active Duty Wartime or Campaign Badge Veteran
Non-Participation: I have read the above statement and I have chosen not to complete this form.
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Disabled and Veteran Self-Identification Information/Definitions

Salt River Electric is a federal contractor subject to Section 503 of the Rehabilitation Act of 1973, as amended, and the Vietnam Era
Veterans Readjustment Act of 1974 (VEVRAA), as amended. Section 503 prohibits job discrimination because of disability by
employers holding federal contracts or subcontracts and requires such employers to take affirmative action to employ and advance in
employment qualified individuals with disabilities who, with or without reasonable accommodation, can perform the essential
functions of a job.

VEVRAA requires government contractors to take affirmative action to employ and advance in employment protected
veterans. If you have a disability or are a protected veteran and would like to participate in our affirmative action program, please complete the form
provided or contact your local HR/EEO Representative.

Disclosure of your status is voluntary. Choosing not to provide this information will not subject you to any adverse treatment. Information you submit concerning your disability will be kept confidential, except:
(i) supervisors/managers may be informed of work restrictions or accommodations;
(ii) safety/first aid personnel may be informed if emergency treatment may be required;
(iii) government officials may be informed as required by law.

Definitions:

  • Disabled Veteran: A veteran entitled to compensation under laws administered by the VA, or discharged for a service-connected disability.
  • Recently Separated Veteran: A veteran discharged within the past 3 years.
  • Active Duty Wartime or Campaign Badge Veteran: A veteran who served during a war or campaign with an authorized badge.
  • Armed Forces Service Medal Veteran: A veteran who participated in a U.S. military operation awarded a service medal.

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