Addax Electric Inc. Employment Application

For Official Use Only
EMPLOYMENT APPLICATION
ADDAX Electric provides equal employment opportunity to all qualified persons and does not unlawfully discriminate against any person based on race, color, creed, religion, sex, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
Position Applying For
Personal Information
1. Name

First NameLast Name
2. Social Security
3. Driver's License (State/No)
4. Address (Street)
5. Address (City, State, Zip Code)
6. Phone Number
7. Alternate Phone Number
8. Email
example@example.com
General Information
Are you legally eligible to work in the U.S.A?

Yes (Verification will be required)No
Have you ever worked for Addax before?

YesNo
If yes, When?
Are any of your relatives currently working for Addax?

YesNo
If yes, please list name and department if applicable.
Employment Request
If applicable, are you available for overtime?

YesNo
What is the earliest date you can begin work?

MonthDayYear
Date
How did you hear about this position?

RecruiterInternet Job PostingClassifiedsCompany WebsiteOther
Employment History
May we contact your current employer?

YesNoNot Applicable
1. Employer
Address
Supervisor
Telephone:
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Reason for Leaving
Position Duties:
2. Employer
Address
Supervisor
Telephone:
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Reason for Leaving
Position Duties:
3. Employer
Address
Supervisor
Telephone:
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Reason for Leaving
Position Duties:
Education

School

	Name	Location	Course of Study	Degree Obtained
High School/GED
College/University
Graduate School
Vocational/Specialized

Military (Optional)
Military Service:

YesNo
Dates:
Branch
Specialized Training

References

	Name	Company	Title	Contact Information

Signature/Certification
I certify that the facts set forth in this application are true, complete, and correct to the best of my knowledge. I understand that any misrepresentations, falsifications, or omissions on this application can be grounds for rejection of my application or, if I am employed by this company, for my immediate termination from employment. I authorize ADDAX Electric to make any necessary inquiries and investigations into my education, military, or employment history. I further authorize, unless otherwise indicated on this application, the release of my information to ADDAX Electric by any of the schools, services, or employers listed on this application.
Printed Name
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

For Official Use Only

EMPLOYMENT APPLICATION

Personal Information

General Information

Employment Request

Employment History

Education

Military (Optional)

Signature/Certification