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Personal Information

Employment Desired

 

Education

High School

College

 

Trade/Business School

 

Former Employers

(List below the last three (3) employers, starting with the most current)

Employer 1

Employer 2

 

Employer 3

 

References

(List below the names of three (3) persons whom you have known at least one year)

Reference 1

 

Reference 2

 

Reference 3

 

I authorize investigation of all statements contained in this application. I understand the misrepresentation or omission of facts called for is cause for dismissal. I further authorize investigation of my character, general reputation, personal characteristics and mode of living. I understand my right under the Fair Credit Reporting Act to request disclosures of the nature and scope of any such investigation.

Mayfield Electric & Water Systems is governed by the provision of KRS 96.740. In accordance with KRS 96.740(3),
any person who is related within the third degree to any member of the Electric Board, the Mayor of the City of Mayfield, or any member of the Mayfield City Council shall not be eligible for employment by Mayfield Electric & Water Systems.

I understand the provision of KRS 96.740(3) and hereby certify that I am not related within the third degree to any member of the Electric Plant Board, the Mayor of the City of Mayfield, or any member of the Mayfield City Council.