Maynard Company Employment Application

Form
1. Employer Information
Employer: Maynard Electric Company
Address: PO Box 8310, Morganton, NC 28680
Telephone: 828-544-5056 Fax: 828-527-0875

It is the policy of Maynard Electric Company to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability, or veteran status.
2. Applicant Information

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Daytime Phone Number

Area CodePhone Number
Evening Phone Number

Area CodePhone Number
Social Security Number
Driver's License Number
Email
3. Emergency Contact Name
Relationship to you
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number

24. Please include any other skills you have that may pertain to this job.
25. Skills: Check all that apply if any.

Gas Metal Arc WeldingGas Tungsten Arc WeldingShielded Meta Arc WeldingFlux Cored Arc WeldingFabrication WeldingMig & Tig Welding
Years of Experience: Gas Metal Arc Welding
Years of Experience: Gas Tungsten Arc Welding
Years of Experience: Shielded Meta Arc Welding
Years of Experience: Flux Cored Arc Welding
Years of Experience: Fabrication Welding
Years of Experience: Mig & Tig Welding

28. Applicant’s Employment History
List your current or most recent employment first:
Employer Name:
Supervisor Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Duties
Pay Rate
Reason for Leaving
Dates of Employment(Month/Year)
Employer Name
Supervisor Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Duties
Pay Rate
Reason for Leaving
Dates of Employment(Month/Year)
Employer Name
Supervisor Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Duties
Pay Rate
Reason for Leaving
Dates of Employment(Month/Year)

29. Applicant’s Education and Training
College/University Name and Address
Did you receive a degree?

YesNo
If yes, degree received:
High School/GED Name and Address
Did you receive a degree?

YesNo
Other Training (graduate, technical, vocational):
Awards, Honors, Special Achievements:
Military Service:

YesNo
Branch:
Specialized Training:
28. References

List any two people who would be willing to provide a reference for you.
First and Last Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Relationship
First and Last Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Relationship

1. Please provide any other information that you believe should be considered:
CERTIFICATION
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Maynard Electric Company to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to communicate information fully and freely regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my pervious employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Owner, the employment relationship will be “at-will”. In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and
without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have that right. Moreover, no agent, representative, or employee of Maynard Electric Company, except in a specific written contract of employment signed on behalf of the organization by its
Owner, has the power to alter or vary the voluntary nature if the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.
Signature

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