Please

Print

Name

Last

First

Middle

Social Security Number

Today’s Date

Present Address

How Long?

City

State & Zip

Present Phone No.

Are you legally employable in the United States?

Former Address                                               City, State & Zip                      How long?

Position Applied For

Part Time                              Full Time

Salary Desired

$                                       Per

Date Available

Other positions for which you feel you are qualified.

State your long-range career objective.

Were you referred to us?   

If yes, by whom?

Encircle highest grade or number of years completed

Grade School

  4     5     6     7     8

High School

    1     2     3     4  

Junior College

    1     2     3

College

     1     2     3     4     5     6     7

Names and locations of schools

Did you graduate?

Course of Study or Degree Earned

High School(s)                                                                                          City                                               State

College(s)                                                                                                  City                                               State

List any special schooling: (military, correspondence, trade school, etc.)

Are you presently a member of the National Guard or Reserves?          Yes  _____       No _____

Veteran       Yes _____   No _____                 Dates of service:      From _____________________________ to ________________________________

Type of training received ______________________________ Rank achieved ______________________ Branch of service _____________________

Type of work performed ______________________________________________________________________________________________________

Employer

Address

Your Job

Month/Year

From - To

Earnings

Company name

Street address

Name of immediate supervisor

City, State & Zip

Phone Number

Reason for leaving

Summarize your job duties

Employer

Address

Your Job

Month/Year

From - To

Earnings

Company name

Street address

Name of immediate supervisor

City, State & Zip

Phone Number

Reason for leaving

Summarize your job duties

Employer

Address

Your Job

Month/Year

From - To

Earnings

Company name

Street address

Name of immediate supervisor

City, State & Zip

Phone Number

Reason for leaving

Summarize your job duties

Which of the above jobs did you like best? ________________________________________________Why? ___________________________________

Do you prefer a job with a variety of duties? ________ What kind of work would you like most to do, if all paid the same? ________________________

What are your hobbies and interests? __________________________________________________________________________________________________________________________

Have you ever been convicted for any offense other than minor traffic law violations?  Give details. _________________________________________

__________________________________________________________________________________________________________________________

Personal references:  Give name, address and phone number of two local references other than two relatives or former employers.

1. ________________________________________________________________________________________________________________________

2. ________________________________________________________________________________________________________________________

Industry references:  Do you know other people in the electrical industry?  Give name and company. _________________________________________

In signing this application form, I clearly understand and agree:  (1) that all the statements are true to the best of my knowledge; (2) that no attempt has been made to conceal or withhold pertinent information; (3) I authorize investigation of all statements with no liability; (4) any falsification or misrepresentation may be considered cause for termination; (5) I will abide by all company rules and regulations if hired; and (6) I agree to take physical examinations at the company’s request and at their expense to determine my suitability for present and continued employment if hired.

Signed ______________________________________________________________________  Date ____________________________