Personal History Questionnaire - Tennessee Valley Authority

EMPLOYMENT HISTORY (continued)
Do not leave gaps. Do not list unemployment office or local union to verify employment or unemployment.
Unemployed:
From:
To:
Employer’s Name: (No initials or abbreviations)
Name of person who can verify:
Daytime Phone No:
Employed/Self‐Employed From:
/ /
Evening:
Home Office Address: Position Held: Phone No:
( )
Job Site Location: (City/State)
Reason for Termination*:
Fired Laid‐Off Quit
Employed/Self‐Employed To:
/ /
Eligible for Rehire*:
Yes No
If Self‐employed or employer out of business (check one), provide person who can verify activities:
Name: Phone No: ( )
Unemployed:
From:
To:
Name of person who can verify:
Daytime Phone No:
Evening:
Employer’s Name: (No initials or abbreviations)
Employed/Self‐Employed From:
/ /
Home Office Address: Position Held: Phone No:
( )
Job Site Location: (City/State)
Reason for Termination*:
Fired Laid‐Off Quit
Employed/Self‐Employed To:
/ /
Eligible for Rehire*:
Yes No
If Self‐employed or employer out of business (check one), provide person who can verify activities:
Name: Phone No: ( )
Unemployed:
From:
To:
Employer’s Name: (No initials or abbreviations)
Name of person who can verify:
Daytime Phone No:
Employed/Self‐Employed From:
/ /
Evening:
Home Office Address: Position Held: Phone No:
( )
Job Site Location: (City/State)
Reason for Termination*:
Fired Laid‐Off Quit
Employed/Self‐Employed To:
/ /
Eligible for Rehire*:
Yes No
If Self‐employed or employer out of business (check one), provide person who can verify activities:
Name: Phone No: ( )
Unemployed:
From:
To:
Employer’s Name: (No initials or abbreviations)
Name of person who can verify:
Daytime Phone No:
Employed/Self‐Employed From:
/ /
Evening:
Home Office Address: Position Held: Phone No:
( )
Job Site Location: (City/State)
Reason for Termination*:
Fired Laid‐Off Quit
Employed/Self‐Employed To:
/ /
Eligible for Rehire*:
Yes No
If Self‐employed or employer out of business (check one), provide person who can verify activities:
Name: Phone No: ( )
*If fired or not eligible for rehire, provide explanation at bottom of page 12.
X
Applicant’s Full Printed Name
Social Security Number
TVA 40932 (BLUE), INI / UPA / R1Y (12-31-2012) RESTRICTED INFORMATION Page - 10 - of 26