Electric Services, Inc.

Electric Services, Inc.

Application for Employment
PRE-EMPLOYMENT AGREEMENT
Please Read Carefully.
I understand that Electric Services, Inc. is a “Drug Free Workplace” and as such requires that all applicants must submit to a drug screen as a condition of employment. I further understand thatany offer of employment by the company is contingent upon passing the drug screen.

If I receive an offer of employment, I will be given a copy of the company’s drug and alcohol abuse policy and will be asked to complete all necessary drug and alcohol testing forms at that time.

I hereby freely and voluntarily agree to submit to drug testing and I understand that refusal to submit to the testing or failure to qualify according to the minimum standards established by Electric Services, Inc. for this testing will cause my immediate dismissal. I also agree to retake the test if the specimen level is too low for an accurate screening.
Applicant Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
How did you hear about ESI?*
What is the employee's name that referred you?
Social Media Platform*

FacebookInstagram

Application for Employment
PLEASE READ THIS APPLICATION THOROUGHLY AND COMPLETE IT HONESTLY.
ELECTRIC SERVICES, INC. PERFORMS A DETAILED BACKGROUND
INVESTIGATION ON CONDITIONALLY HIRED EMPLOYEES.
IMPORTANT NOTICE: If you need assistance in completing this application, please contact the office. Applicants should be extremely careful as they complete this application. Electric Services, Inc. utilizes a sophisticated and detailed background and post-employment investigation process. This process frequently discloses inaccurate, false and/or incomplete or omitted information. Should this process
determine any inaccurate or incomplete information, it will result in termination of employment if the inaccuracies are discovered. Accordingly, Electric Services strongly suggests that you NOT complete this application until you have the time and accurate information to do so. Electric Services is an equal opportunity employer and will not discriminate against any employee or applicant for employment in any manner prohibited by law. If you feel you have been unfairly treated or discriminated against for any reason, please call this to the attention of the administrative office so that we may address your concerns.

By signing this application, I represent that the information provided in this form is given voluntarily and may be used in filing reports required by state and federal governments and agencies and for any other purpose not prohibited by law. Electric Services requires all individuals who successfully completed the initial employment screening process to submit to a drug screening program, which may include the
taking of blood and/or urine samples, and reserves the right to require that all employees submit to a drug and alcohol testing during the course of their employment. The result of such screening will be initially disclosed to decision makers for Electric Services for purposes related to employment. By signing this application, I agree to the foregoing and further agree to hold Electric Services harmless for any claims resulting from such screening for drug and /or alcohol use.

NOTE: All applicants will be required to furnish proof of identity and legal work authorization to be considered for employment.

EMPLOYMENT INFORMATION
Position Applied For Position Desired Salary $ Salary
Type of employment desired?

Full TimePart TimeTemporary
PERSONAL DATA
Applicant's Name*

First NameMiddle NameLast Name
List any names you currently use or have used at any time, including any nicknames, aliases, stagenames, or any other names.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
When is the best time to contact you at work?

Hour Minutes

AM/PM Option
At home?

Hour Minutes

AM/PM Option
Social Security Number*
BACKGROUND DATA
Have you ever been convicted of a crime, had an adjudication of a crime withheld, or pled nolo contendere to a crime? Yes No
If yes, please state the circumstances with regard to each.
*NOTE: Answering “Yes” may not necessarily disqualify you from the position desired. Each action and explanation will be weighed/considered in relationship to the position for which you are applying.

EMPLOYMENT HISTORY
Please list, beginning with your most recent employment (starting with your current employer), any and all prior work experience which you have had during the past 10 years. Be sure to account for any periods of unemployment.
Number of Previous Employers*
Employer #1*
- Employer #2
- Employer #3
- Employer #4
- Employer #5

Have you ever applied for employment with or been employed by Electric Services before? Yes No*
If so, please set forth all positions held, dates of employment and reason(s) for leaving.
Highest level of education completed Name of Institution City State
If employed by us, will you continue to receive other compensation of any kind from any other employer or entity for services concurrently performed on behalf of that employer or entity? Yes No*
Please describe any other experience, abilities, skills or credentials which you feel add to your qualifications for the position sought with us.

State the number of times you were absent from work during the last 12 months
Please explain, in your own words, why you want to work at Electric Services, in what position(s), and any other information you feel should be considered in connection with your employment application
I UNDERSTAND that this application will only be considered “active” for 30 calendar days from the date of application. If I have not obtained employment with Electric Services within 30 days, but remain interested in obtaining employment with Electric Services, I understand that I must notify Electric Services in writing of my desire for my application to be considered for an additional 30 days.*

I UNDERSTAND
I UNDERSTAND that if a conditional offer of employment is made to me, all statements made by me in connection with my application for employment may be checked by Electric Services. I authorize Electric Services to contact my prior employers, including each of those employers listed in paragraph no. 7, and other sources of information, regarding my background, and I hereby authorize and direct each such employer and source of information to answer any and all questions regarding my prior employment and background.*

I UNDERSTAND
I UNDERSTAND that if a conditional offer of hire is made to me by Electric Services, Electric Services will perform a background investigation pursuant to the separate Disclosure Authorization for Release of Information signed by me. This investigation may result in the preparation of an investigative consumer report which would include information as to the applicant’s character, general reputation, personal characteristics and mode of living. I understand I may submit a written request toElectric Services for a complete and accurate disclosure of the nature and scope of the requested investigation.*

I UNDERSTAND
I UNDERSTAND that if a conditional offer of hire is made to me by Electric Services, Electric Services will perform a background investigation pursuant to the separate Disclosure Authorization for Release of Information signed by me. This investigation may result in the preparation of an investigative consumer report which would include information as to the applicant’s character, general reputation, personal characteristics and mode of living. I understand I may submit a written request toElectric Services for a complete and accurate disclosure of the nature and scope of the requested investigation.*

I UNDERSTAND
IF EMPLOYED, I agree to conform to the rules and regulations of Electric Services. I understand that as a condition of my employment and continued employment, I will be required to submit to, and do voluntarily agree to submit to any testing for the presence of drugs or alcohol, and to submit to procedures to assess my qualifications for employment. I also agree that, if hired, my employment is at will; both Electric Services and I have the right to terminate my employment at any time, with or without cause, and with or without notice . I understand that no manager or representative of Electric Services, other than the President of Electric Services, has any authority to enter into any agreement for employment for any specified period of time or make any agreement contrary to the foregoing either now, in the past or in the future. I further understand that even such an agreement must be in writing and signed by the President for it to be binding on either myself or Electric Services. I further understand that this supersedes any prior oral or written understanding and bars any future oral understanding to the contrary.*

I AGREE
I UNDERSTAND that any misstatements or omissions in this application will result in a decision not to hire me, or to discharge me if discovered only after hire.*

I UNDERSTAND
I ACKNOWLEDGE and AGREE that if at any time I am subjected to any type of discrimination or harassment, I will contact Electric Services’ office immediately to obtain assistance in the resolution of such matters.*

I ACKNOWLEDGE AND AGREE
I HEREBY REPRESENT AND WARRANT that I have read and fully understand the foregoing and seek employment under these conditions of my own free will and in accordance with my own judgment.*

I HEREBY REPRESENT AND WARRANT
Applicant's Signature*
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Today's Date*

MonthDayYear
Date
Please verify that you are human*
For Office Use Only

Hired by:___________________________ Date:________________

Date Reporting for Work: __________________________________

Hourly Wage/Salary:____________________________

Position:______________________ Job #____________________
Should be Empty:

Electric Services, Inc.

PRE-EMPLOYMENT AGREEMENT

Application for Employment

EMPLOYMENT INFORMATION

PERSONAL DATA

BACKGROUND DATA

EMPLOYMENT HISTORY