Custom Electric, Inc. Employment Application

Custom Electric, Inc. is an Equal Opportunity Employer

All qualified applicants will receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, religion, age, sex, handicap, veteran status, marital status, sexual orientation, or any other characteristic protected by law.
Questions with ' * ' are Required to Submit this Application
Position Applying For:*
Personal Data:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please Use Valid Phone Number Including Area Code
E-mail*
example@example.com
If hired, what date could you start?
00-00-0000 Date-Month-Year
Are you legally authorized to work in the U.S.?*

YesNo
Are you at least 18 years of age?*

YesNo
Have you ever been convicted of a felony?*

YesNo
If yes, please give details. A 'yes' answer will not automatically bar you from employment.
Have you been arrested for any matter that is pending trial?*

YesNo
If yes, please explain
Do you have a valid Drivers License?*

YesNo
State issued:
Drivers License Number:
Drug Testing

Custom Electric, Inc. is a drug free work environment. Before an offer of employment or at any time during employment, you may be asked to take a drug test.
I understand I may be asked to take a drug test as a condition of employment:*

YesNo
Education
High School*
City & State*
Did you graduate?*

YesNoGED
Have you completed a two-year post-high school course in electrical wiring from which you received a Degree in Electrical Technology?*

YesNo
If Yes, Name & Location of School or Trade Association:
Attended From:
Date:
To:
Date:
Date Diploma or Degree Received:
Have you completed a four-year or five-year Apprentice Electrician program?*

YesNo
If Yes, Name & Location of apprentice electrical program.
Date apprenticeship Began:
Date:
Date apprenticeship ended:
Date:
What Certifications & Licenses do you have?*

Apprentice Electrician LicenseJourneyman Electrician LicenseMaster Electrician LicenseResidential WiremanNone
For all selected above, please list the issuing authority, License #, year, license issued & expiration date, and status of license: active or inactive.
Please list any other licenses or certificates held that are applicable.
Employment History

List below your previous employers starting with present or last employer listed first.
Present or Last Employer (1)*
Employed From:*
Date:
To:*
Date:
If still employed, may we contact this employer?*

YesNo
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please Use Valid Phone Number Including Area Code
Your Position:*
Supervisor:*
Starting Pay; indicate by hour, week, month or other*
Ending Pay; indicate by hour, week, month or other*
Reason for Leaving:*
Prior Employer (2)*
Employed from:*
Employed to:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please Use Valid Phone Number Including Area Code
Your Position:*
Supervisor:*
Starting Pay; indicate by hour, week, month or other*
Ending Pay; indicate by hour, week, month or other*
Reason for Leaving:*
Prior Employer (3)
Employed From:
Date:
To:
Date:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Please Use Valid Phone Number Including Area Code
Your Position:
Supervisor:
Starting Pay; indicate by hour, week, month or other
Ending Pay; indicate by hour, week, month or other
Reason for Leaving:
References

(Please do not use family members)
1) Full Name*

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please Use Valid Phone Number Including Area Code
Relationship?*
Years known?*
2) Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please Use Valid Phone Number Including Area Code
Relationship?
Years known?
3) Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Please Use Valid Phone Number Including Area Code
Relationship?
Years known?
Cover Letter if desired
Upload Resume if Available

Cancelof
By submission, I hereby state that all the information provided on this application is true and correct and that my signature will be required at the time of an interview. If hired, I will provide my Social Security number to finalize employment qualifications.

I authorize Custom Electric, Inc. to investigate my responses on this application and contact any or all of my former employers (unless above you checked the box not to call) or any individuals familiar with me or my employment background for the purpose of verifying any information I provided.
Custom Electric, Inc.
may contact you via e-mail or phone
for an interview if necessary.

You may make inquiries to Jeremy@CustomElectricInc.com
Check this box to certify that you have read and accept the above statements.*

Yes, I accept the above statement
Thank You for Applying at Custom Electric, Inc.
Should be Empty:

Custom Electric, Inc. is an Equal Opportunity Employer

Personal Data:

Drug Testing

Education

Employment History

References

By submission, I hereby state that all the information provided on this application is true and correct and that my signature will be required at the time of an interview. If hired, I will provide my Social Security number to finalize employment qualifications.

Thank You for Applying at Custom Electric, Inc.