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Employment Application
Name
*
Name
First
First
Last
Last
Address
*
City
*
State
*
Zip Code
*
Personal Phone ###-###-####
*
Business Phone #
Email
Age
*
Yes
No
Are you 18 years old?
Position Applying For
Do you have an Electrical License?
Yes
No
License #
State / City
License #
State / City
License #
State / City
Date you are available?
Salary Desired
Are you currently employed?
*
Yes
No
IF SO, may we contact your current employer?
*
Yes
No
What type of work are you looking for?
*
Regular Full-time work
Regular Part-time work
Temporary work
Are you Legally allowed to work in the US?
*
Yes
No
Do you have reliable transportation?
*
Yes
No
Who referred you to this company?
*
Ad for job opening
Employment Agency
Walk in
Unemployment Office
Friend / Family
Employee
Name of who referred you
*
Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation?
*
Yes
No
If no, describe the functions that cannot be performed / accommodations needed.
School Level
High School
College / University
Vocational / Business
Other
Did you graduate?
Yes
No
Name & Location of School
# of years completed
Degree / Diploma
NAME OF PRESENT OR LAST EMPLOYER
*
Address
City
State
Zip Code
Job Title
Start Date
Leave Date
May we contact your supervisor?
Yes
No
Starting Wage
Final Wage
Supervisor (Name & Title)
Phone #
Description of Job Duties
Reason for Leaving
NAME OF PREVIOUS EMPLOYER
Address
City
State
Zip Code
Job Title
Start Date
Leave Date
May we contact your supervisor?
Yes
No
Starting Wage
Final Wage
Supervisor (Name & Title)
Phone #
Description of Job Duties
Reason for Leaving
NAME OF PREVIOUS EMPLOYER
Address
City
State
Zip Code
Job Title
Start Date
Leave Date
May we contact your supervisor?
Yes
No
Starting Wage
Final Wage
Supervisor (Name & Title)
Phone #
Description of Job Duties
Reason for Leaving
MILITARY EXPERIENCE: Please list special skills or abilities acquired in the service.
CONVICTIONS: Have you ever been convicted of a criminal offense (Felony or Serious Misdemeanor)?
*
Yes
No
If YES, state the nature of the crime(s), when and where convicted, and disposition of the case(s).
Convictions will not necessarily disqualify an applicant for employment.
Special Licenses or Certifications
Other Experience, Training, Qualifications, or Skills that you feel are relevant to employment with this company.
PROFESSIONAL REFERENCES
Name
Title
Company
Phone #
Years Associated
Name
Title
Company
Phone #
Years Associated
Name
Title
Company
Phone #
Years Associated
AUTHORIZATIONS
Truthfulness of Application:
*
I certify that the facts set forth in this employment application are true and complete to the best of my knowledge. I understand that the misrepresentation or omission of material facts may result in termination of my employment.
Authorization to Investigate:
*
I authorize any of the persons or organizations referenced in this application to give Gilliam Electric, Inc. any and all information concerning my previous employment, education, or other information they might have, with regard to any of the subjects covered by this application, and release all such parties from the liability for any damage that may result from furnishing such information. I authorize Gilliam Electric, Inc. to request and receive such information.
At-Will Relationship:
*
I understand and agree that if I am offered employment with Gilliam Electric, Inc. it will be on an "at-will" basis. This means that either I or Gilliam Electric, Inc may terminate the employment relationship at any time for any reason, with or without cause. I further understand that the "at-will" nature of my employment with Gilliam Electric, Inc. is an aspect of employment that cannot be modified or changed, except by a written agreement signed by the chief executive officer of Gilliam Electric, Inc. I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and Gilliam Electric, Inc.
I agree that the below name represents my signature
*
Date
If you are human, leave this field blank.
Submit
