Personal History Questionnaire - Tennessee Valley Authority

SECTION VI ‐ EMPLOYMENT HISTORY
If you have NOT held Unescorted Access at a nuclear plant within the last 3 years, list all employment / unemployment for last 5 years.
If you HAVE held Unescorted Access within the last 3 years, list all employment / unemployment since last access.
Do not leave gaps. Do not list unemployment office or local union to verify employment or unemployment.
Have you been fired, involuntarily terminated, or forced to leave any job or position, except as part of a
reduction in force, within the past five (5) years YES NO If Yes, explain the circumstances and reason for
leaving at bottom of page 12.
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:
Name of person who can verify:
Daytime Phone No:
Evening:
*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 - 8 - of 26