Clites Electric Construction Inc

Clites Electric Construction Inc
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
Date
Age
Marital Status
What position are you applying for?

Journeyman ElectricianApprentice Electrician
Do you have a South Dakota Drivers License?

YesNo
Have you ever been convicted of a crime?

YesNo
If you answered yes to the above question, please explain briefly indicating the nature and dates of the offense
Date available for work

MonthDayYear
Date
(Check one)

Full TimePart TimeTemporary
Referred by
EDUCATION & TRAINING
What is the highest grade you completed?

9101112GED
Electrical Apprenticeship Year

1234
High School
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From

MonthDayYear
Date
To

MonthDayYear
Date
Diploma

YesNo
Vocational
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From

MonthDayYear
Date
To

MonthDayYear
Date
Diploma

YesNo
College
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From

MonthDayYear
Date
To

MonthDayYear
Date
Diploma

YesNo
Journeyman License #
Apprentice License #
EMPLOYMENT HISTORY

(Must be completed in full)
LIST BELOW YOUR WORK EXPERIENCE BEGINNING WITH THE MOST RECENT JOB
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Supervisor
Job Duties
From
To
Salary Beginning
Salary End
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Supervisor
Job Duties
From
To
Salary Beginning
Salary End
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Supervisor
Job Duties
From
To
Salary Beginning
Salary End
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Supervisor
Job Duties
From
To
Salary Beginning
Salary End
Personal References

Please list three personal references that have known you for at least three or more years.

	Name	Address	Phone Number
Reference 1
Reference 2
Reference 3

I realize that my application shall remain active for 90 days from the date of completion. If I am not hired during this period, a new application must be completed.

I certify that the information given is true and correct. I understand any misrepresentations or omissions of fact, whenever discovered shall cause for rejection of this and subsequent applications and for discipline including immediate termination.

Clites Electric Construction Inc may investigate my past employment including references. Final approval for employment will be subject to this investigation.

I understand that if I am offered and accept employment, that it is specific term, and that my employment may be terminated at will, by either my employer or myself.
Should be Empty:

Clites Electric Construction Inc

EDUCATION & TRAINING

EMPLOYMENT HISTORY

Personal References