Please provide the following contact information:

First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Please identify and describe yourself:

Date of Birth	Example 06/12/1972
Sex	Male Female

Have you been employed by this company before?

Yes No If Yes, Please provide details in comments box below

          Education?

High School / GED Certified Electrical License Trade or Vocational School Associates Degree Bachelors Degree Other

If other, Please provide information in comments box below

Years as a Journeyman Electrician?

0 1 2 3 4 5 +

Do you have a valid drivers license?

Your driving record will be checked if you will drive a company vehicle.

Yes No                                                                                      Please provide State in which license is issued in comments below

Do you have your own mode of transportation?

Yes No

During the last 7 years, have you ever been convicted of, pled guilty to or pled no contest to a crime, excluding misdemeanors and traffic violations? 

If yes, please provide details in comments box below                             (A conviction will not necessarily bar you from employment)

Yes No  

Military Service:

Does not apply U.S Army U.S Air Force U.S Navy U.S Marine Corps U.S Coast Guard

Date Entered

Example 06/12/1972

Date Discharged

Example 06/12/1972

Rank at discharge: Example: SSgt / E5

Type of Discharge:

Not Applicable Honorable General Dishonorable

(A dishonorable discharge will not necessarily bar you from employment)

Do you have service related skills applicable to civilian employment?

Not applicable Yes No

Please feel free to provide additional information or comments to questions required in this application.

Additional information will provide us a clearer understanding of your skills and experience. Forward current resume or list previous work related employment history below.

This Company is an equal opportunity employer. In all employment practices, including hiring.  We are firmly committed to equal opportunity without regard to race, religion, color, sex, age, national origin, citizenship, disability or any other basis of discrimination prohibited by applicable local, state or federal law. No questions on this employment application is used for the purpose of limiting or excluding any applicant's consideration for employment on such grounds.

I Hereby certify that I have read and fully completed this preliminary application and that the facts set forth in this employment questionnaire are true and correct to the best of my knowledge and I agree and understand that any misrepresentation or falsification of information or omission of information during the employment application may disqualify me from further consideration for employment or will subject me to dismissal.  I further certify that I am true and bona fide job applicant, honestly interested in working in the position(s) for which I have applied and seeking employment with this company solely to provide me with benefits of a job and for no other purpose.