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AMERICAN SAMOA POWER AUTHORITY

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AMERICAN SAMOA POWER AUTHORITY
PO BOX PPB, Pago Pago, American Samoa 96799
EMPLOYMENT
APPLICATION
ASPA Human Resources
Ph: (684) 699-3033
Email: humanresource@aspower.com
ASPA provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race,
color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information,
marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws except for
bona fide occupational or legal requirements. IMPORTANT: Please read the instructions carefully before filling in each
section. Answer each question briefly, but as completely as required. Type or print clearly your answers in the space
provided. If an item does not apply to you or if there is no information to be given, please write in the space provided, N/A,
meaning not applicable. This application will be used for evaluation only. You are in no way obligating yourself by
submitting it nor is its acceptance by the American Samoa Power Authority to be interpreted as a commitment of any kind. If
you need information about employment or assistance to completing this application form please contact the Department
of Human Resources.
AMERICAN SAMOA POWER AUTHORITY
APPLICATION FOR EMPLOYMENT
Page 2 of 5
DOCUMENTS REQUIRED
Please attach the following documents with your application:
□ Birth Certificate/Passport □ Diploma(s)
□ Social Security Card □ Resume (Optional)
□ Photo ID □ Any relevant certifications
PERSONAL INFORMATION
Mr. Mrs. Miss
(please circle)
Last Name: First Name: MI: Suffix:
Phone Number(s):
Address (Street or Post Office Box Number):
Email Address:
City or Village, State:
Zip Code:
Social Security No.
XXX-XX-
Birthplace:
Date of Birth:
EMPLOYMENT DESIRED
Please list the types of jobs which, as an employee, you would feel most qualified to perform by order of
preference.
How did you hear about the positions you listed above? Please check all that apply.
□ Samoa News □ Employee Referral
□ ASPA Website □ HR Bulletin Board
□ ASPA’s Facebook Page □ Other: _________________________
EDUCATION
Please indicate the highest school grade completed. □ 12 □ 13 □ 14 □ 15 □ 16+ □ Other: __________
Name of College or University
Start Date
End Date
Years/Degree earned
Use the space below to list any special qualifications, licenses, certificates, skills, special schools, or training you
have attained. Please be specific and list the date, location, and any other pertinent information:
First
Second
Third
AMERICAN SAMOA POWER AUTHORITY
APPLICATION FOR EMPLOYMENT
Page 3 of 5
EXPERIENCE
Please complete the following section in reverse chronological order with your most recent employment listed
first.
Dates of employment (month, year)
From: To:
Job Title:
Present Salary: $ per
Employer:
Number of employees supervised:
Address:
Name of immediate supervisor:
Contact Info. Tel: Email:
Reason for wanting to leave:
Job Duties:
Dates of employment (month, year)
From: To:
Job Title:
Present Salary: $ per
Employer:
Number of employees supervised:
Address:
Name of immediate supervisor:
Contact Info. Tel: Email:
Reason for wanting to leave:
Job Duties:
Dates of employment (month, year)
From: To:
Job Title:
Present Salary: $ per
Employer:
Number of employees supervised:
Address:
Name of immediate supervisor:
Contact Info. Tel: Email:
Reason for wanting to leave:
Job Duties:
Dates of employment (month, year)
From: To:
Job Title:
Present Salary: $ per
Employer:
Number of employees supervised:
Address:
Name of immediate supervisor:
Contact Info. Tel: Email:
Reason for wanting to leave:
Job Duties:
IMMIGRATION STATUS In all cases of employment, first consideration shall be given to persons eligible for
permanent residence within the Territory of American Samoa.
Are you legally eligible to work in the United States? Can you show proof of citizenship/visa/alien registration if
we decide to hire you? Yes □ No □
AMERICAN SAMOA POWER AUTHORITY
APPLICATION FOR EMPLOYMENT
Page 4 of 5
LANGUAGE
Please indicate languages used.
Languages Used
Spoken
Written
Samoan
□
Excellent
□
Fair
□
Poor
□
Excellent
□
Fair
□
Poor
English
□
Excellent
□
Fair
□
Poor
□
Excellent
□
Fair
□
Poor
Other:_________
□
Excellent
□
Fair
□
Poor
□
Excellent
□
Fair
□
Poor
HISTORY
Please answer the following questions in the space provided.
Have you ever worked for ASPA before? If so, please indicate the period of time you were employed, your
position, and your reason for leaving:
Do you have close relatives currently working for ASPA? If yes, list names below.
Do you have a valid driver’s license? Yes □ No □
Commercial driver’s license? Yes □ No □
Within the last five (5) years have you been fired from any job for any reason? If yes explain:
Within the last five (5) years have you resigned from any job after having been notified that you would be
suspended or fired? If yes, explain:
Have you ever been convicted of a crime, forfeited collateral, or are you now under charges for any crime other
than minor traffic offenses? You may answer “No” if the conviction occurred before your 21st birthday. If yes,
explain:
If you were a member of the military were you honorably discharged? □ Yes □ No □ I was never in the military
AMERICAN SAMOA POWER AUTHORITY
APPLICATION FOR EMPLOYMENT
Page 5 of 5
ATTENTION: After completing all questions, please sign and date. A false answer to any question may be grounds for non-
employment or for discharge after employment. All statements are subject to investigation, including a check of police
records and contacting former employers.
BY SIGNING BELOW I CERTIFY THAT ALL THE STATEMENTS MADE ON THIS APPLICATION ARE TRUE, COMPLETE
AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. THE AMERICAN SAMOA POWER AUTHORITY,
DEPARTMENT OF HUMAN RESOURCES IS AUTHORIZED TO VERIFY MY CREDENTIALS AND PRIOR EMPLOYMENT SET
FORTH IN THIS APPLICATION.
__________________________________________ _____________________________
Applicant’s Signature Date
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AMERICAN SAMOA POWER AUTHORITY

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Completed 30 July 2021

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