Employment Application

Personal Info

First Name:

Last Name:

Home Phone:

Work Phone:

Cell Phone:

Address:

City:

State:

Zip:

Email:

How did you hear about us?

Employment Info

Current Employer:

Years of Work Experience directly related to the position you are applying for:

Employment Type Desired:

Full Time Part Time

Desired Compensation:

Other Compensation Desired:

When are you available to start work?

Education

High School

College or University

Bus. or Trade School

Criminal History

Have You Ever Been Convicted of a Felony or Misdemeanor (except any minor traffic violations)?

Yes No

If Yes, please explain

Drivers License Information

Do You Have a Driver's License?

Yes No

Do you have reliable transportation to work (please be specific)?

Driver's License #:

State of Issue:

Type:

Operator Commercial (CDL) Chauffeur

Do You Have a Clean Driving Record?

List any Moving Violations and/or Accidents from the last 3 years:

Military Service

Have You Ever Been in the Armed Forces?

Yes No

Branch:

Are You Currently a Member of the National Guard or Reserves?

Yes No

Specialty:

Date Entered:

Discharge Date:

Work Experience

Please list your work experience for the past 5 years beginning with your most recent job.

If you were self-employed, give firm name. Attach additional sheets if necessary. Attach Resume if applicable.

Please Upload any Files Here

Employer

Name of Employer:

Employer Address:

Name of Last Supervisor:

Employment Dates:

Pay or Salary:

Your Last Job Title:

Specific Reason for Leaving:

May We Contact This Employer?

Yes No

Employer

Name of Employer:

Employer Address:

Name of Last Supervisor:

Employment Dates:

Pay or Salary:

Your Last Job Title:

Specific Reason for Leaving:

May We Contact This Employer?

Yes No

Employer

Name of Employer:

Employer Address:

Name of Last Supervisor:

Employment Dates:

Pay or Salary:

Your Last Job Title:

Specific Reason for Leaving:

May We Contact This Employer?

Yes No

Employer

Name of Employer:

Employer Address:

Name of Last Supervisor:

Employment Dates:

Pay or Salary:

Your Last Job Title:

Specific Reason for Leaving:

May We Contact This Employer?

Yes No

Electrical Industry Skills

ELECTRICAL INDUSTRY SKILLS SECTION INSTRUCTIONS: ONLY select the specific industry skills that you consider yourself to be very knowledgeable about, with a high level of competency.

Certifications & Licenses

What Certifications & Licenses do you have? (Select all that apply)

Apprentice Electrician License Journeyman Electrician License Master Electrician License

Include State and License Numbers for any licenses selected above, if applicable:

Other Licenses & Certifications held:

Additional Information

Please summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. If you have a resume, please include it with this application.

Attach Your Resume

Professional References

Please list 3-4 people you have worked with who can attest to your On-the-Job experience and performance.

Reference

Reference Name:

Phone:

Email:

Position:

Company:

Reference

Reference Name:

Phone:

Email:

Position:

Company:

Reference

Reference Name:

Phone:

Email:

Position:

Company:

Reference

Reference Name:

Phone:

Email:

Position:

Company:

Did You Complete this Application Yourself?

Yes No

If Not, Who Did?

AGREEMENT (PLEASE READ CAREFULLY BEFORE SIGNING)

I certify that all the information on this application is accurate and complete to the best of my knowledge and understand that misleading or false statements will constitute sufficient cause for refusal of hire or termination of my employment.

I understand that neither the acceptance of this application nor the subsequent entry into any type of employment relationship with DNB Electrical Contracting, Inc. creates an actual or implied contract of employment.

I understand that, if I accept employment with DNB Electrical Contracting, Inc., it will be on an at-will basis. This means that either DNB Electrical Contracting, Inc. or I have the right to terminate the employment relationship at any time, for any reason, with or without cause.

I agree to submit to drug and alcohol testing, if requested by DNB Electrical Contracting, Inc. I release DNB Electrical Contracting, Inc. and its employees, plus other persons or companies, from any and all liability arising out of or related in any way to such testing.

I authorize DNB Electrical Contracting, Inc. to investigate information concerning my education, licensing, certifications, driving record, criminal history, employment experiences and all other aspects of my background relevant to my proposed employment. I release DNB Electrical Contracting, Inc. and its employees from all liability arising from such investigation.

Your Full Name (this will serve as your signature)

Date