Personal Information

First and Last Name

Phone

Address, City, State:

Employment

Desired Position:

Date You Can Start:

Salary Desired:

Are you employed now?

Yes No

May we present contact employer for other concerns?

Yes No

Do you have a valid driver's license?

Yes No

Your availability to work?

Full-Time Part-Time Temporary

Additional Comments:

General Information

Electrical experience/Special Skills:

Former Employers (List below your past employers, starting with the last one first)

Company 1:

Address:

Salary:

Position:

From:

Reason for Leaving:

Company 2:

Address:

Salary:

Position:

From:

Reason for Leaving:

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PLEASE CAREFULLY READ BEFORE SIGNING AND AGREEING TO THE FOLLOWING:
CERTIFICATION AND AGREEMENT

I certify that all information contained in this application and any attachments are true and complete to the best of my knowledge. I understand that any willful misrepresentation, false statement, or omission by me in the application or interview process will be cause for rejection of my application or termination of my employment. I authorize an investigation of my work and personal history which is job-related and of all statements made on this application and attachments. I certify that I will hold no person, corporation, or organization liable for giving or receiving information in such an investigation.

Employment Application

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