SAFE Electric Careers Form

Safe Electric. LLC 6635 Singletree Dr Columbus, OH 43229 614-267-4111
Personal Information
Full Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Are you 18 years or older ?

Yes No
Today's Date

Month Day Year
Date
Position Applied For
Start Date

Month Day Year
Date
Desired Pay
Are you Currently Employed

Yes No
If Yes, may we contact your present employer ?
Would you like to work

Full time only Part Time only Full or Part Time
Do you have any kind of restrictions for the applied position?

Yes No
If yes, please explain
Certificate/Licenses
Skills (may not be necessary for the job you seek) Please fill out an evaluation of your skills:
Customer Service Skills

Excellent Good Fair A Little None at all
Typing & Computer Competency

Excellent Good Fair A Little None at all
Working knowledge of a multi-line phone

Excellent Good Fair A Little None at all
Leadership Skills

Excellent Good Fair A Little None at all
Willingness to train others

Excellent Good Fair A Little None at all
Critical Thinking Skills

Excellent Good Fair A Little None at all
Ability to read different personality types and adapt accordingly.

Excellent Good Fair A Little None at all
Education
high school or last grade completed
Name & Address
Course of Study
# of years completed
Degree/Diploma
College Or Technical School
Name & Address
Course of Study
# of years completed
Degree/Diploma
Other Schooling or Training
Name & Address
Course of Study
# of years completed
Degree/Diploma
Employment History
Employer
Phone
Address
Position Title
Supervisor & Title
Start Date

Month Day Year
Date
Date Left

Month Day Year
Date
Start Salary
End Salary
Duties
Reason for Leaving
Employer
Phone
Address
Position Title
Supervisor & Title
Start Date

Month Day Year
Date
Date Left

Month Day Year
Date
Start Salary
End Salary,
Duties
Reason for Leaving
Employer
Phone
Address
Position Title
Supervisor & Title
Start Date

Month Day Year
Date
Date Left

Month Day Year
Date
Start Salary
End Salary
Duties
Reason for Leaving
Military
Branch
Final Rank
Assignment
Dates of Service

Month Day Year
Date
Are you a member of the National Guard?

Yes No
References (no relatives)
Name
Occupation
Years known
Contact Information
Name
Occupation
Years known
Contact Information
General
If hired, can you provide documents required to establish your eligibility to work in the U.S?

Yes No
Will you be able to perform the job functions for the position you are applying for with or without reasonable accommodations?

Yes No
Are you willing to undergo a background check and drug screening?

Yes No
Do you have reliable method of transportation to work?

Yes No
Would there be any reason why you would be uninsurable as a driver?

Yes No
If Yes, please explain
Electrical Field Technician - additional questions
Please list any relevant work experience that may be helpful to this position?
How many years experience do you have on residential service calls?
If applying for an Apprenticeship role, what related experience to you have?
Fill in the blanks
I am strongest at
I am weakest at
My favorite part of residential service and repair is
My least favorite part of residential service and repair is
Do you have any experience in sales?

Yes No
Explain
Waiver Agreement and Statement for Criminal History Checks
This form must be completed and signed by every current or prospective employee, volunteer and contractor/vendor, for whom criminal history records are requested by a qualified entity, school or organization.

I hereby authorize Safe Electric, LLC to run a comprehensive background check, for the purpose of accessing and reviewing Ohio and national criminal history that may pertain to me directly from the appropriate agencies. By signing this Waiver Agreement, it is my intent to authorize the dissemination of any criminal history record that may pertain to me to the Qualified Entity with which I am or am seeking to be employed. I understand that, until the criminal history background check is completed, you may choose to deny me unsupervised access to clients homes, the office or company vehicles. I further understand that, upon request, you will provide me with copy of the criminal history background report, if any, you receive on me and that I am entitled to challenge the accuracy and completeness of any information contained in any such report. I may obtain a prompt determination as to the validity of my challenge before you make a final decision about my status as an employee, volunteer, contractor or subcontractor.
Have you ever been convicted of a felony ?

Yes No
If Yes, Describe the crime(s) and the particulars of the conviction(s)
Signature

Clear
Printed Name
Address
Date of Birth

Month Day Year
Date
Today's Date

Month Day Year
Date
Application Statement
I understand this application is not a contract of employment. I understand should the employer hire me and should any of the information I have given in the application be found false, misleading, or incomplete, I shall be subject to dismissal. I understand all hired persons must provide proof of identity and authorization to work in the U.S. Failure to produce such proof will result in denial of employment. I certify that all the information given on this application is complete and true. I understand that employment with Safe Electric LLC is at-will, meaning that I or the Company may terminate my employment at any time, or for any reason consistent with applicable state or federal laws.

I authorize the Company to conduct a thorough background investigation of my work and personal history, and verify all data given on this application and during interviews. I hereby release the Company, and its representatives or agents, from any liability that might result from such an investigation. I authorize all individual, school, and firms named to provide any requested information and release them form all liability for providing the requested information. I understand that the Company requires the successful completion of a drug and/or alcohol test as a condition of employment. Iunderstand this application will be active for 60 days; after that time, if I wish to be considered for employment, I must submit a new application. I certify that all the statements in this completed application are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire.
Printed Name
Address
Date of Birth

Month Day Year
Date
Today's Date

Month Day Year
Date
Signature of Applicant

Clear
Date

Month Day Year
Date
Please Upload Resume

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