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Employee Application Form
Employee Application Form
Step
1
of
6
16%
Personal Information
What is your full name?
(Required)
First Name
Middle Name
Last Name
Current Address
(Required)
No. & Street
City
State
ZIP Code
Permanent Address (if different from Current Address)
No. & Street
City
State
ZIP Code
Contact Information
Email Address
(Required)
Phone
(Required)
General Information
Employment Desired
Position applying for:
(Required)
How did you hear about our company and this job opening?
(Required)
General Information (cont.)
Have you ever applied to or worked for Remington Electrical Services? ……...
(Required)
Yes
No
If yes, when?
Why are you applying for work at Remington Electrical Services?
If hired, would you have reliable means of transportation to and from work?
(Required)
Yes
No
Are you at least 18 years old (if under 18, hire is subject to verification that you are of minimum legal age).
(Required)
Yes
No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
(Required)
Yes
No
If no, describe the function that cannot be performed
(Required)
Are you certified journeyman?
(Required)
Yes
No
For journeyman, enter your certification number
(Required)
Are you currently enrolled in an electrical apprenticeship program?
(Required)
Yes
No
If so, which program?
(Required)
(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical exam and to a skill and agility test.)
We may refuse to hire relatives of present employees if doing so could result in actual or potential problems in supervision, security, safety, or morale, or if doing so could create conflicts of interest.
Education, Training, and Experience
High School
Name
School Address
City
State
ZIP Code
No. of Years
Did you Graduate?
Yes
No
Degree or Diploma
Education, Training, and Experience (cont.)
College/ University
Name
Address
City
State
ZIP Code
No. of Years
Did you Graduate?
Yes
No
Degree or Diploma
Vocational/ Business
Name
Address
City
State
ZIP Code
No. of Years
Did you Graduate?
Yes
No
Degree or Diploma
Health Care Training
Name
Address
City
State
ZIP Code
No. of Years
Did you Graduate?
Yes
No
Degree or Diploma
Employment History
List below all present and past employment, starting with your most recent employer (last five years is sufficient). You must complete this section even if attaching a resume.
Name of Employer
Phone Number
Type of Business
Supervisor's Name
Address
Address & Street
City
State
ZIP Code
Start Date
(Required)
MM slash DD slash YYYY
End Date
(Required)
MM slash DD slash YYYY
Current Employer?
(Required)
Yes
No
Your Position and Duties
(Required)
Reason for Leaving
(Required)
May we contact this employer for a reference?
(Required)
Yes
No
References
List below three persons not related to you who have knowledge of your work performance within the last three years.
Name
First
Last
Phone
Phone Number
Address
Address & Street
City
State
ZIP Code
Occupation
No. of Years Acquainted
Name
First
Last
Phone
Phone Number
Address
Address & Street
City
State
ZIP Code
Occupation
No. of Years Acquainted
Name
First
Last
Phone
Phone Number
Address
Address & Street
City
State
ZIP Code
Occupation
No. of Years Acquainted
Application Agreement
Please read carefully, initial each paragraph, and sign below.
Initials
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
Initials
I hereby authorize Prime Electrical Services to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment (excluding criminal background information) unless otherwise specified above. I further authorize the references I have listed to disclose to Prime Electrical Services any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Prime Electrical Services, my former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.
Initials
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 Prime Electrical Services. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and Prime Electrical Services’ designated representative.
Initials
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.
Initials
I understand that Prime Electrical Services is a drug-free workplace and that, as part of my application, I will be required to take a drug test. In addition, I understand that, should I not pass the drug test, I will no longer be considered for employment.
Date
(Required)
MM slash DD slash YYYY
Signature
(Required)
