Employment Application

Personal Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Do you have a valid driver's license?*

Yes
No

Valid driver's license number*

Work Eligibility

Are you eligible to work in the U.S?*

Yes
No

Are you at least 18 years or older?*

Yes
No

(If no, you may be required to provide authorization to work.)

Can you work overtime, including weekends?*

Yes
No

Have you ever been terminated from employment or asked to resign by an employer?*

Yes
No

If yes, please provide company names and details.*

Do you have any felony convictions?*

Yes
No

If yes, please explain and include approximate date(s):*

We run background checks and honesty counts. Circumstances of convictions can be considered if listed here.

Job Details

Do you have a valid Journeyman Electrician's License?

Yes
No

If yes, please provide License Number & Jurisdiction

Hourly Rate / Salary desired?*

Date you can start*

Are you currently employed?*

Yes
No

If so, may we inquire of your present employer?*

Yes
No

If No, how long since your last employment?*

Referral Type*

Referral Source*

Education

Fill in the applicable education and training below.

High School

School Name

Location

Degree received?

Yes
No

Trade, Business, or Correspondence School

School Name

Location

Number of Years Attended

Please enter a number less than or equal to 99.

Degree received?

Yes
No

College or University

School Name

Location

Number of Years Attended

Please enter a number less than or equal to 99.

Degree received?

Yes
No

Work History

Include your last three employers, including periods of unemployment, starting with the most recent and working backwards in time.

Incomplete information could disqualify you from further consideration.

Current or Previous Employer

Employer 1 Name*

From*

(MO/YR)

To*

(MO/YR)

Position Held

Salary/Wage

Reason for Leaving?*

Employer 1 Supervisor Name*

Employer 1 Phone*

Employer 1 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Previous Employer

Employer 2 Name*

From*

(MO/YR)

To*

(MO/YR)

Position Held

Salary/Wage

Reason for Leaving?*

Employer 2 Supervisor Name*

Employer 2 Phone*

Employer 2 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Previous Employer

Employer 3 Name*

From*

(MO/YR)

To*

(MO/YR)

Position Held

Salary/Wage

Reason for Leaving?*

Employer 3 Supervisor Name*

Employer 3 Phone*

Employer 3 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Submit

Resume

(Optional)

Signature*

Name Date

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