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EMPLOYMENT

Personal Information

Name

Phone

Select an Address

Employment Desired

Desired Position

Desired Start Date

Desired Pay

Are you employed now? *

Yes

If so, may we inquire about your current employment? *

Yes

Ever applied to this company before? *

Yes

Previous Appliciation Details. Where and when did you apply.

Educational History

High School

Name of School/Years Attended

Did you graduate? *

Yes

College

Name of School/Years Attended

Did you graduate? *

Yes

Trade, Business or Correspondance School

Name of School/Years Attended

Did you graduate? *

Yes

General Information

Current Electrical License(s) Held:

Special Training

Special Skills

Former Employers

List below your last four employers, starting with the most recent.

Name and Address of Employer

Position/Dates

Reason for Leaving

Name and Address of Employer

Position/Dates

Reason for Leaving

Name and Address of Employer

Position/Dates

Reason for Leaving

Name and Address of Employer

Position/Dates

Reason for Leaving

Personal References

List the names of 3 persons not related to you, whom you have know at least 1 year.

Name and Address of Referral

Business

Years Known

Name and Address of Referral

Business

Years Known

Name and Address of Referral

Business

Years Known

AUTHORIZATION

Allied Electrical Group is an EQUAL OPPORTUNITY EMPLOYER. To help us comply with government record-keeping requirements, we would appreciate your completing the following information. You are not required to provide this information. If you choose not to provide this information, your decision Will NOT affect your application. This data Will be confidential and will only be used in accordance with applicable state and federal laws and regulations.

Date of Birth:

Sex *

Male

Female

Prefer not to say

Veteran *

Yes

Disabled *

Yes

Ethnic Code *

Caucasian

African American