Employment Application

1145 BELLBROOK AVENUE
XENIA, OHIO 45385
EMPLOYMENT APPLICATION
Thank you for your interest in applying for a position with Reddy Electric Company. Because of our commitment to offering the highest possible satisfaction to our customers, we are interested in hiring the best. We want to have a complete understanding of your qualification, motivations and interests, so that we can make careful and deliberate hiring decisions that will benefit both Reddy Electric Company and our employees. Please answer the questions on the employment application honestly, completely and thoughtfully. In responding to questions on this application, continue on a separate sheet of paper if you require more space. We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex, national origin, age, marital status, veteran status, qualified disability or any other status or condition protected by law.
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PERSONAL INFORMATION
DATE OF APPLICATION:

MonthDayYear
Date
Last Name:
First Name
Middle Name
Street
City
(Apartment number)
State
Zip Code
E-Mail
example@example.com
Alternate E-Mail
example@example.com
Phone Number

Area CodePhone Number
Alternate Number

Area CodePhone Number
Can we e-mail you with Reddy Electric Co. related information?

YESNO
If you are under 18 years of age, do you have a work permit certificate of age?

YESNO
If you have ever worked under a different name, please identify:
Do you have, or have you applied for the legal right to remain permanently and work in the United States?

YESNO
Have you ever been discharged or asked to resign by an employer?

YESNO
If YES, please explain:
A record of criminal conviction will not necessarily be a bar to employment, since Reddy Electric Company will consider factors such as age, time of the offense, the nature and seriousness of the violation, and evidence of rehabilitation in making any employment decision.
Have you ever been discharged or asked to resign by an employer?

YESNO
If YES, please explain:
JOB INTERESTS
POSITION DESIRED:
SALARY EXPECTATIONS:
Hr.
Wk.
Mo.
Are you available for full-time work?

YESNO
Are you available for part-time work?

YESNO
Are you willing to travel?

YESNO
Are you willing to work any shift?

YESNO
Which days of the week are you able to work (please check)?

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
CONTINUED
Will you work overtime?

YESNO
Date you can start work:

MonthDayYear
Date
How did you learn of this job opening?
Have you ever worked for Reddy Electric Co?

YESNO
When?
Your supervisor’s name:
Why did you leave?
Have you received a referral from a current employee? if yes, Who?
Do you know anyone who works at Reddy Electric Company if yes, Who?
WORK HISTORY
ALL APPLICANTS MUST ACCOUNT FOR THE LAST 10 YEARS
Starting with your present or last job, include and account for all periods of time, unemployment and military service for the last 10 years. If you need additional space, please continue on a separate sheet of paper. Even if you mark "no" indicating that you prefer we not contact your current employer at this time, your current or most recent employer may be contacted AFTER a job offer has been made and accepted.

Begin with your current or most recent employer.
Are you presently employed?

YESNO
Are you on a layoff and subject to recall?

YESNO
If yes, to where?
#1 Present or Last Employer:
Address

Address

Street Address Line 2

CityState

Zip
Type of Business:
Phone:
Starting Position:
Pay:
Final Position:
Pay:
From: Month/Year:
To: Month/Year:
Name & Title of Supervisor:
Description of Work Responsibilities:
Reason for Leaving:
Will you receive a satisfactory reference from this employer?

YESNO
If “no”, please explain:
May we contact your present employer at this time?
YESNO
If “no”, please explain:
Are you on a layoff and subject to recall?
YESNO
If yes, to where?
#2 Present or Last Employer:
Address

Address

Street Address Line 2

CityState

Zip
Type of Business:
Phone:
Starting Position:
Pay:
Final Position:
Pay:
From: Month/Year:

MonthDayYear
Date
To: Month/Year:
CONTINUED
Name & Title of Supervisor:
Description of Work Responsibilities:
Reason for Leaving:
Will you receive a satisfactory reference from this employer?

YESNO
If No, please explain:
Are you presently employed?

YESNO
Are you on a layoff and subject to recall?

YESNO
If yes, to where?
#3 Present or Last Employer:
Address

Address

Street Address Line 2

CityState

Zip
Type of Business:
Phone:
Starting Position:
Pay:
Final Position:
Pay:
Dates Employed: From: Month/Year:

MonthDayYear
Date
To:

MonthDayYear
Date
Name & Title of Supervisor:
Description of Work Responsibilities:
Reason for Leaving:
Reason for Leaving:
Will you receive a satisfactory reference from this employer?

YESNO
Will you receive a satisfactory reference from this employer?
Are you presently employed?

YESNO
Are you on a layoff and subject to recall?
Are you on a layoff and subject to recall?

YESNO
If yes, to where?
EDUCATIONAL DATA
High School:
Address:
City:
State:
Zip Code:
Did you graduate?

YESNO
“No”, Highest grade achieved: NO
Have you received your GED?

YESNO
College:
Address:
City:
State:
Zip Code:
Major:
Dates Attended:

MonthDayYear
Date
Degree Received:
Grade Point Average:
Apprenticeship, Trade, Business or Correspondence School:
CONTINUED
Address

Address

Street Address Line 2

CityState

Zip Code
Major:
Dates Attended:

MonthDayYear
Date
Degree Received:
Grade Point Average:
Degree Received:
OSHA 10: Date Issue:

MonthDayYear
Date
Card #:
First Aid: Date Issue:

MonthDayYear
Date
Card #:
OSHA 30: Date Issue:

MonthDayYear
Date
Card #:
CPR/AED: Date Issue:

MonthDayYear
Date
Card #:
F.A. License: Exp. Date:

MonthDayYear
Date
Card #:
Arc Flash: Exp. Date:

MonthDayYear
Date
Card #:
MILITARY EXPERIENCE
Have you ever been in the United States Armed Services?

YESWhat Branch? NO
Have you ever been in the United States Armed Services?

NavyMarinesAir ForceArmyCoast GuardOther
Describe any skills you acquired in the Service, which would be useful to the job for which you are applying:
REFERENCES
List the names of any professional references who have known you for at least three years and from whom you can obtain letters of recommendation. Do NOT list relatives.
1. Name:
Occupation:
Work Phone:
Home Phone:
Cell / or Other
Relationship to Applicant:
2. Name:
Occupation:
Work Phone:
Home Phone:
Cell / or Other
Relationship to Applicant:
3. Name:
Occupation:
Work Phone:
Home Phone:
Cell / or Other
Relationship to Applicant:
PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING:
By signing below, I certify that I have read, understand and agree to each of the following statements
- knowledge, and I have not knowingly withheld any information that, if known to Reddy Electric Company, would aect my application unfavorably.
All of the information I have supplied on this application is true, accurate and complete, to the best of my
- answers on this application are false, misleading, or incomplete, I may be dismissed immediately from my job.
If Reddy Electric Company hires me and if is discovered at any time during my employment that any of the statements or
- for a job with Reddy Electric Company after this period, I must ll out another application. However, if I am hired, I recognize that this employment application becomes a part of my ocial employment record and remains in eect during the duration of my employment.
This employment application will be considered active for ninety (90) days from the date below. If I want to be considered
- Reddy Electric standards prior to employment. I release Reddy Electric, its employees, and any aliated persons or compa nies from any and all liability arising out of or related in any way to such testing.
I agree to submit to drug and/or alcohol testing. I understand that I must pass the drug and/or alcohol tests according to
- relating to variuos potential employment tasks and/or safety issues. I understand that my passing the exams will be cosidered in the hiring process. In consideration of my employment with Reddy Electric Company I also agree to abide by all the company’s rules and regulations.
I understand as part of the pre-employment process i must view a number of educational information and complete exams
- and the physical work environment for which I am being considered. Thereafter, I release and authorize Reddy Electric Company or its designee to receive and review all medical information including but not limited to, les, reports, x-rays, evaluations, and opinions held by medical personnel, to the extent such information is job-related and consistent with Reddy Electric Company's business necessity. I acknowledge that this is a general release and that, if hired, it remains in eect for the duration of my employment.
If I am oered employment, I agree to submit to a medical exam, if requested, to assess my suitability for the position
- Company and me. If I am hired by Reddy Electric Company, my employment and compensation will be "at will," which means that my employment can be terminated, either by Reddy Electric Company or me, with or without cause, and with or without notice. I understand that no manager or supervisor has the authority to make any employment agreement with me, either orally or in writing, that changes this at-will status. Only the President of Reddy Electric Company has the authority to enter into any employment agreement for any specied period of time with me, and only in writing.
I understand that nothing in this employment application creates a contract of employment between Reddy Electric

In the event of any personal indebtedness I have to Reddy Electric Company, I authorize the company to withhold from my wages such amounts as permitted by law to satisfy my obligation to Reddy Electric Company.
- employment application (and accompanying resume, if any), that Reddy Electric Company thinks is necessary to determine my qualications for assuming a job with the company. I give Reddy Electric Company my permission to contact former employer, school, college or university, utility company, credit or nance bureau or oce, any personal or professional reference, or any other appropriate source or individual for the purpose of gathering information, personal or otherwise, that such sources may have about my character, general reputation, credit, education, or employment record, and I give my consent to any such source to release to Reddy Electric Company whatever information they have about me. I also unconditionally release all named and unnamed sources from any and all liability, which might result from furnishing any information about me.
I give Reddy Electric Company my permission to conduct any investigation regarding the information contained in my
- companies or subsidiaries must be led no more than six (6) months after the date of the employment action that is the subject of such claim or lawsuit. I waive any statute of limitations to the contrary.
I agree that any claim or lawsuit relating to my employment with Reddy Electric Company or any of its employees, aliated
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1145 BELLBROOK AVENUE

XENIA, OHIO 45385

EMPLOYMENT APPLICATION

PERSONAL INFORMATION

JOB INTERESTS

SALARY EXPECTATIONS:

CONTINUED

WORK HISTORY

ALL APPLICANTS MUST ACCOUNT FOR THE LAST 10 YEARS

CONTINUED

EDUCATIONAL DATA

CONTINUED

MILITARY EXPERIENCE

REFERENCES

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING: