LMZ ELECTRICAL STAFFING
APPLICANT INFORMATION
Full Legal Name
First Name
Last Name
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
Format: (000) 000-0000.
Email Address
example@example.com
Alternate Phone
Format: (000) 000-0000.
Preferred Contact Method
Phone
Text
Email
Are you at least 18 years old?
Yes
No
Rows
Emergency Contact Name
Relationship
Emergency Contact Phone
1
POSITION AND AVAILABILITY
Position(s) Applying For - check all that apply
Electrical Helper
Apprentice Electrician
Journeyman Electrician
Lead / Foreman
Service Electrician
Low Voltage Technician
Other
Rows
Desired Hourly Pay
Available Start Date
Hours Available Per Week
1
Employment Preference
Full-Time
Part-Time
Temporary
Project / Contract
Shift Availability
Day
Night
Weekend
Overtime
On-Call
Project Availability
Local
Out-of-Town Travel
Long-Term Projects
Shutdowns
Can you reliably report to assigned job sites?
Yes
No
Valid driver license?
Yes
No
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EXPERIENCE AND CREDENTIALS
EXPERIENCE AND CREDENTIALS
Rows
Total Years of Electrical Experience
Commercial
Industrial
Residential
1
Current Classification
Helper
Apprentice
Journeyman
Foreman
Other
Rows
Electrical License / Registration Number
Issuing State
Expiration Date
1
Licenses and Certifications - check all currently held
OSHA 10
OSHA 30
NCCER
NFPA 70E
CPR / First Aid
Aerial Lift
Forklift
Arc Flash
Lockout / Tagout
Confined Space
Other Certifications / License Details
ELECTRICAL SKILLS
Check the systems and tasks you can perform independently or with limited supervision.
EMT Conduit
Rigid / IMC
PVC Conduit
MC / AC Cable
Cable Tray
Underground
Wire Pulling
Terminations
Lighting / Controls
Panels / Breakers
Switchgear
Transformers
Motors / Controls
VFDs
PLC / Instrumentation
Fire Alarm
Generators / ATS
Blueprint Reading
Layout / Bending
Troubleshooting
Meters / Testing
Low Voltage / Data
Service Work
Crew Supervision
Describe your strongest electrical skills, typical project experience, and crew leadership experience (if any).
Apprenticeship Program / School (if applicable)
Completed Hours / Year
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LMZ ELECTRICAL STAFFING
EMPLOYMENT HISTORY
List your three most recent employers, beginning with the most recent. Staffing assignments may be listed by staffing company and primary project.
Employer #1
Company
Supervisor
First Name
Last Name
Phone
Format: (000) 000-0000.
Rows
Job Title
From
To
Hourly Pay
Reason for Leaving
1
Employer #2
Employer #2
Rows
Company
Supervisor
Phone
1
Rows
Job Title
From
To
Hourly Pay
Reason for Leaving
1
Employer #3
Company
Supervisor
First Name
Last Name
Phone
Format: (000) 000-0000.
Rows
Job Title
From
To
Hourly Pay
Reason for Leaving
1
EDUCATION AND TRAINING
EDUCATION AND TRAINING
Rows
High School / GED
City / State
Graduated? (Yes / No)
1
Trade School / College
Program / Degree / Certificate
PROFESSIONAL REFERENCES
Reference #1 Name
First Name
Last Name
Company / Relationship
Phone
Format: (000) 000-0000.
Reference #2 Name
First Name
Last Name
Company / Relationship
Phone
Format: (000) 000-0000.
Reference #3 Name
First Name
Last Name
Company / Relationship
Phone
Format: (000) 000-0000.
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LMZ ELECTRICAL STAFFING REQUIREMENTS & CERTIFICATION
JOB READINESS
Tools and Personal Protective Equipment
Own basic hand tools
Own required power tools
Own basic PPE
Own meter
Can you perform the essential functions of the position, with or without reasonable accommodation?
Yes
No
Are you legally authorized to work in the United States?
Yes
No
Will you now or in the future require employment sponsorship?
Yes
No
Have you previously worked for LMZ Electrical LLC?
Yes
No
If yes, when?
Additional Information / Project Preferences / Scheduling Restrictions
APPLICANT CERTIFICATION AND AUTHORIZATION
I certify that all information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that false statements, omissions, or misrepresentations may disqualify me from consideration or result in termination if employed. I authorize LMZ Electrical LLC and its representatives to contact the employers, schools, references, and licensing or certification authorities listed in this application to verify job-related information. I understand that employment is not guaranteed by submitting this application and that any employment relationship may be subject to company policies, client requirements, background screening, drug testing, safety rules, and proof of authorization to work, as permitted by law.
Applicant Signature (type full legal name)
First Name
Last Name
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Equal Employment Opportunity Statement
LMZ Electrical LLC is an equal opportunity employer. Employment decisions are made without unlawful discrimination based on race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable law.
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