Employment Application

Date*

Date

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Area CodePhone Number

How many years have you lived at your current address?

Position applying for?

Employment desired?*

Full-Time OnlyPart-Time OnlyTemporary / Contract

Are you over the age of 18?*

YesNo

Age?

Are you currently authorized to work in the United States?*

YesNo

Wage Desired (Be Specific)

When are you available to start work?*

How many hours can you work weekly?*

HIgh School

College

Business or Trade School

Professional School

Have you ever been convicted of a felony? ( A conviction record will not necessarily disqualify you from employment. )*

YesNo

Employee Referral?

First NameLast Name

Have you ever been in the Armed Forces?

YesNo

Are you now a member in the Armed Forces?

YesNo

Specialty

Date Entered

Date

Discharge Date

Date

Attach additional files if necessary - File 1

Browse Files

Attach additional files if necessary - File 2

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Employer 1

Name of Employer, Address, City, State, Zip Code, Phone Number

Name of Supervisor

Employment Dates

From / To

Pay or Salary

Start / Finish

Last Job Title

Reason for leaving

Be Specific

Employer 2

Name of Employer, Address, City, State, Zip Code, Phone Number

Name of Supervisor

Employment Dates

From / To

Pay or Salary

Start / Finish

Last Job Title

Reason for leaving

Be Specific

Employer 3

Name of Employer, Address, City, State, Zip Code, Phone Number

Name of Supervisor

Employment Dates

From / To

Pay or Salary

Start / Finish

Last Job Title

Reason for leaving

Be Specific

May we contact your present employer?

YesNo

Did you complete this application yourself?*

YesNo

After reviewing the above job description, please indicate if you are able to perform the essential functions of the job for which you have applied, with or without a reasonable accommodation?*

YesNo

Have you worked at MD Electric before?*

YesNo

Please Read Carefully

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am hired, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

We are an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age , height, weight, or disability. We assure you that your opportunity for employment with us depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.

Name - e-signature*

Date*

Date

Resume

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Employment Application - MD Electric

Schooling

Military

Work Experience