GRIGG ELECTRIC COMPANY, INC.

Date*

Name*

SS #*

DOB*

State & Drivers Lic #*

Street*

City*

State*

Zip*

Phone*

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?*

YesNo

Position*

Date you can start*

Salary Desired*

If electrician, do you have a NC State Electrical License?*

YesNo

If electrician, do you have a City of Asheville Electrician's Journeyman Card?*

YesNo

If electrician or apprentice, do you have the proper hand tools to perform electrical installations?

YesNo

Can you perform the essential functions of the job(s) for which you are applying?*

YesNo

Are you available to work*

Full-timePart-timeOver-time

Have you ever applied to Grigg Electric before?

YesNo

When

Have you ever worked for Grigg Electric before?

YesNo

Date

Referred By

	Name & Location of School	No of Years Attended	Did You Graduate	Subjects Studied
High School
College
Trade or Business School

Have you been convicted of a felony?*

YesNo

If yes, please explain (include dates)

Are you currently employed?*

YesNo

May we contact your present employer?*

YesNo

If yes, give name & phone number

Are you or have you been in the US Military or Naval Service?*

YesNo

If yes, give details (include rank)

This company is an equal employment opportunity employer. All applicants will be considered without regard to age, race, national origin, religion, disability, sex, or another protected status in accordance with applicable federal and state equal employment opportunity laws. This company will strive to accommodate any physical or mental limitations of employees or applicants in order to accomplish the essential functions of the job.

From*

Date

To*

Date

Name & Address of Employer*

Salary*

Position*

Reason for Leaving*

From

Date

To

Date

Name & Address of Employer

Salary

Position

Reason for Leaving

From

Date

To

Date

Name & Address of Employer

Salary

Position

Reason for Leaving

Select the field that describes the majority of your electrical experience.*

IndustrialCommercialResidential

Which of these jobs did you like best? & why?*

	Name	Address & Phone Number	Business	Years Acquainted
1
2
3

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE SIGNED AND DATED ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK THEM BEFORE SIGNING.

I certify that all answers and statements I have made on this application (and resume or other supplementary materials) are true and complete without omissions. By signing below, I authorize Grigg Electric to investigate all statements contained in this application as they may deem necessary in arriving at an employment decision. I understand that any false information provided by me will likely result in a refusal to hire or immediate discharge if I am employed. I authorize any of the persons or organizations named in this application to give you complete information and records regarding my employment, education, character, and qualifications.

If hired I will be responsible for familiarizing myself with all rules and regulations of Grigg Electric as they presently exist or are later modified. If hired, I understand my employment can be terminated at the discretion of Grigg Electric or my option, without notice, at any time and for any reason.

I also understand that no representative of Grigg Electric has any authority to enter into any employment agreement for any specific period of time or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the President of Grigg Electric.

I understand this application is not an offer of employment and no promises or representations of employment have been made to me at this time.

I have read, understand, and agree with the above.

Signature of Applicant*

Date*

GRIGG ELECTRIC COMPANY, INC.

PERSONAL INFORMATION

Address

EMPLOYMENT DESIRED

EDUCATION

GENERAL

EMPLOYMENT EXPERIENCE

First Experience

Second Experience

Third Experience

REFERENCES