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Notice to Applicants

We welcome you as an applicant for employment. It is the policy of Blackfoot Telecommunications Group to consider applicants for all positions without regard to race, color, creed, religion, sex, national origin, age, marital status, qualified disability, veteran status or any other legally protected status unless related to a bona fide occupational requirement.

* = required
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Position Applied For:
Date:
Apr 29 2017

Personal

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Last Name:
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First Name:
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Middle Name:
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Present Address:
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City:
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State:
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Zip:
*
Business Phone:
*
Cell Phone:
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E-mail:
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May we contact you at work? Yes No
List other names, if any, used on employment or education records.
*
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Yes No
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Are you under 18? Yes No
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Have you ever been convicted of a felony? Yes No If yes, when?
Describe conviction:

(Criminal convictions are not an absolute bar to employment, but will be considered in relation to specific job requirements.)
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Have you ever worked for or are currently working for any Blackfoot Telephone Companies? Yes No


If yes, please give dates and department:

Current or prior position: Reason for leaving:

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Do you have any relatives currently working for Blackfoot or who currently serve on the Board of Trustees? Yes No

If yes, please give their name and relationship:

Education

School Name and Address of School Course of Study Check Last Year Completed Did you Graduate? List Diploma or Degree
High 1
2
3
4
Yes
No
College 1
2
3
4
Yes
No
Other
(specify)
1
2
3
4
Yes
No

Special Skills

Special Skills Relating To The Position Your Are Applying For:
(clerical skills, equipment operating skills, computer skills, line laying experience, flagger training, etc.)

Certificates

Certificates (CPA, PE, Computer, Equipment, etc.)

Name and complete address
of Licensing Agency
Type of License Endorsement/Restrictions
(if applicable)
Date
Licensed
Date Expires
(if applicable)

Driver's License

Driver's License: (if required for this position)
Do you have a valid Driver's License? Yes No State:
Number: Expiration Date:
Do you have a Commercial Driver's License?Yes No
if yes, specify Type: Class:
Endorsements Airbrakes: Other (specify):
Notice to applicant: If the job for which you are applying requires the use of company vehicles,
we will check your driving record if you are a finalist for the job.

Employment History

Employment Experience - This information must be completed even if a resume is submitted.
Instructions: Begin with your present or most recent job and list your work experience with emphasis on experience that is relevant to the position for which you are applying. Include military service and any volunteer work which has provided experience that would help you qualify.

Notice to applicants: Information that you provide on this application is subject to verification. Previous employers may be contacted as references and for verification. May we contact your present employer? Yes No


Current or most recent employer:

Address: City: State: Zip:

Date employed from: To:

Position: Salary:

Contact Name & Title: Phone:

Describe work performed:


Reason for leaving:


Past employer:

Address: City: State: Zip:

Date employed from: To:

Position: Salary:

Contact Name & Title: Phone:

Describe work performed:


Reason for leaving:

Past employer:

Address: City: State: Zip:

Date employed from: To:

Position: Salary:

Contact Name & Title: Phone:

Describe work performed:


Reason for leaving:

References

List three (3) references, excluding relatives, who have knowledge of your ability to perform this job.
Reference Complete Mailing Address Telephone Number
Full name:


Relationship to you:
work:  
cell:     
email:  
Full name:


Relationship to you:
work:  
cell:    
email:  
Full name:


Relationship to you:
work:  
cell:     
email:  

Legal

Reporting

**EEO REPORTING - OPTIONAL**
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of the individual applicants on the basis of visual observation or surname when possible.

Race and Ethnic Identification:
Hispanic or Latino
White (Not Hispanic or Latino)
Black or African American
American Indian/Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Two or More Races
Other:
Gender:
Male
Female
**ADDITIONAL APPLICANT INFORMATION – OPTIONAL**
To assist in our recruiting efforts, please let us know where you heard about the position you are applying for. Thank you for your assistance.
Newspaper Please specify:
Blackfoot.com
Job Search Web site(i.e. Monster, Yahoo., etc). Please specify:
Blackfoot employee
Other. Please specify:

Supporting Docs

Resume:
if you upload it must be a pdf or word doc
Cover Letter:
if you upload it must be a pdf or word doc



Contact Human Resources
If you have any questions, please contact Blackfoot’s Human Resources department at employment@blackfoot.com.