Application For Employment
Date of Application
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
First Name
Middle Initial
Last Name
Date of Birth Month/Day/Year
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
Address
Street Address Line 2
City
State
Zip Code
Telephone Numbers
Format: (000) 000-0000.
Can you provide required proof of your eligibility to work?
Please Select
Yes
No
Have you ever been employed with us before?
Please Select
Yes
No
Are you prevented from lawfully becoming employed in this county because of Visa or Immigration Status?
Please Select
Yes
No
On what date would you be available for work
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you available to work:
Full Time
Part Time
Temporary
Can you travel if a job requires it?
Please Select
Yes
No
Can you work night shift if required?
Please Select
Yes
No
Have you ever been convicted of a felony?
Please Select
Yes
No
If yes, please explain:
Can you bend conduit?
Please Select
If yes, how many years of experience do you have?
Service Truck Experience?
Please Select
Yes
No
If yes, how many years of experience do you have?
Foreman Experience?
Please Select
Yes
No
If yes, how many years of experience do you have?
Education
Rows
Name, City, State of School
Course of Study
# of Years Completed
Degree/ Diploma
High School
Undergraduate
Graduate/ Professional
Other, Specify
Employment History
Classification:
Journeyman Wireman - How Long?
Apprentice Year
Please Select
1
2
3
4
5
6
Employment History
Employer/ Job Title:
Date Employed From:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date Employed To:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employer/ Job Title:
Date Employed From:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date Employed To:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employer/ Job Title:
Date Employed From:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date Employed To:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please Check - Training or Direct Project Experience (Comfortable doing on a job unsupervised)
OSHA-10
Code
Grounding
Hazardous Location
Health Care Facilities
F.O. Terminations
High Voltage Safety
Low Voltage Safety
Power Quality
Communications Systems
Safety
PLC's
First Aid/ CPR
ICRA Training
OSHA - 30
Industrial
Fire Alarm State License (If applicable)
Fire Alarm Exp. Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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