Type of Work Desired
Have you previously been employed by Electrical Associates?
Yes
No
If Yes, when?
Date Available for Employment
MM
DD
YYYY
Employment Interest
Full Time
Part Time
Do you have any friends or relatives employed by Electrical Associates?
Yes
No
If Yes, who?
Name (First, Middle, Last, and any other names used)
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone Number
(###)
###
####
Alternate Phone Number
(###)
###
####
Social Security Number
Email Address
Are you 18 years of age or older?
Yes
No
Do you have a valid driver's license?
Yes
No
Can you provide proof that you are legally eligible for employment in the USA?
Yes
No
Have you ever been convicted of a crime (felony or misdemeanor) or have any prosecutions pending?
Yes
No
If Yes, please explain.
High School Name and Location
Dates Attended
Did you graduate?
Yes
No
GPA
College or University Name and Location
Dates Attended
Major Subject
Did you graduate?
Yes
No
Date Graduated or Expected Gradution
MM
DD
YYYY
Diploma/Degree and GPA
Graduate School Name and Location
Dates Attended
Major Subject
Did you graduate?
Yes
No
Date Graduated or Expected Graduation
MM
DD
YYYY
Diploma/Degree and GPA
Other School Name and Location
Dates Attended
Major Subject
Did you graduate?
Yes
No
Date Graduated or Expected GraduationDi
MM
DD
YYYY
Diploma/Degree and GPA
Special Computer Software Training and/or Skills
Summarize any other skills, licenses, certifications, and qualifications
Name/Address of Current/Last Employer
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Starting Salary
Final Salary
Job TitleS
Supervisor Name and Title
May we contact your supervisor?
Yes
No
Phone Number
(###)
###
####
Description of Work
Reason for Leaving
Name/Address of Last Employer
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Starting Salary
Final Salary
MM
DD
YYYY
Job Title
Name/Title of Supervisor
May we contact your supervisor?
Yes
No
Phone Number
(###)
###
####
Description of Work
Reason for Leaving
Electronic Signature
I agree and understand that Electrical Associates and/or it's agents may investigate my names and dares of previous employers, reason for termination of employment, work experience, accidents, etc., whether same is of record or not. I further understand that such reports may contain public record information concerning my driving record, prior credit history, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies which maintain such records. I release employers and persons named herein from all liability for any and all damages resulting from the furnishing and release of such information .
I have the right to make a request to the Consumer Reporting Agency (CRA), upon proper identification, to request the nature and substance of all Information; and the recipients or any reports on me which the CRA has previously furnished within the two year period preceding my request. I hereby consent to your obtaining the above information from the CRA.
I understand and agree that this application for employment does not obligate Electrical Associates to employment and that any interviews granted may be at my expense.
Once a contingent offer of employment has been made, I agree to furnish any additional information and/or submit to oral, written, or physical examinations, including testing for the presence of controlled substances, bonding and pre-employment processing as may be required to complete the employment file.
In consideration of my employment, I agree to conform to the rules and regulations of Electrical Associates. I understand and agree that should I become employed by Electrical Associates. I will be an employee at will. My employment can be terminated, with or without notice, at any time, with or without cause, at the option of either the company or myself. I further understand that no representative of the company has any authority to enter into any agreement for employment for any specified period of time,or to make any agreement contrary to the foregoing.
I understand that any misrepresentation, omission, or false statement by me in this application, in any supplement thereto, or in any other corporate records including those used in connection with Electrical Associates's drug testing procedures, will be sufficient grounds for not employing me, and may result in dismissal without notice at any time during my employment.
I also acknowledge that Electrical Associates may continue to investigate my background if I am hired, and that my employment may be terminated if that investigation determines that I do not meet Electrical Associates hiring criteria.
Date Signed
MM
DD
YYYY
