Maynard's Electrical

APPLICANT INFORMATION

Maynard's Electric Employment Application

First Name(*)

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Last Name(*)

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M.I.

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Date(*)

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Current Street Address(*)

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Apt. No.

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City(*)

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State(*)

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Zip Code(*)

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Home Phone(*)

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Date of Birth(*)

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Are you a citizen of the United States?

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If no, are you authorized to work in the U.S.(*)

YesNo

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Have you ever worked for this company?(*)

YesNo

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If yes, when?

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Have you ever been convicted of a felony(*)

YesNo

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If yes, explain?

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What position are you applying for?(*)

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Date you can start:(*)

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EDUCATION

High School

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Address

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From

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To

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Did you graduate?

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Degree

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College

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Address

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From

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To

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Did you graduate?

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Degree

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Trade, Business, or Correspondence School

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Address

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From

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To

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Did you graduate?

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Degree

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REFERENCES

Full Name

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Relationship

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Company

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Phone

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Address

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Full Name

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Relationship

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Company

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Phone

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Address

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Full Name

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Relationship

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Company

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Phone

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Address

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PREVIOUS EMPLOYMENT

Company

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Phone

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Street Address

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Supervisor

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Job Title

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Starting Salary

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Ending Salary

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Responsibilities

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From

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To

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Reason For Leaving

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May we contact your previous supervisor for a reference?

Yes No Invalid Input

Company

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Phone

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From

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Street Address

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Supervisor

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Job Title

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To

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Starting Salary

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Ending Salary

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Responsibilities

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Reason For Leaving

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May we contact your previous supervisor for a reference?

Yes No Invalid Input

Company

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Phone

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Street Address

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Supervisor

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Job Title

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Starting Salary

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Ending Salary

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Responsibilities

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From

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To

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Reason For Leaving

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May we contact your previous supervisor for a reference?

Yes No Invalid Input

Licenses-Skills-Certifications

Licenses/Certifications or OSHA Credentials - Type:

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License Number

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State Of Issue

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Expiration Date

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Skills and Equipment you can operate

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U.S. Military Service

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Rank

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Present Membership in the National Guard or Reserves

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DISCLAIMER AND SIGNATURE

I certify that all the information submitted by me on this application is true and complete. I understand that employment is conditioned upon a background check and if any false information, omissions, or misrepresentations are discovered, my application will be rejected
If I am employed, my employment will be "At Will" and may be terminated at any time with or without cause and with or without notice. I also understand the terms and conditions of my employment may change at any time. If employed I agree to conform to all Maynard's Electric rules and regulations. I also agree to submit to any medical examination and drug test as teemed appropriate by the company.
I understand that the filling out of this application or the advent of an interview does not imply a promise for employment and does not obligate Maynard's Electric to hire. Only the President of the company can or will enter into an employment agreement.
Applicants for position that require driving a commercial motor vehicle (CMV) at any time will be required to undergo controlled substances and at our discretion, alcohol testing prior to employment and will be subject to further testing throughout the period of employment. Applicants will also be asked to sign forms for release of information from previous employers where driving a CMV was one of your functions. Failure to sign will prevent this employer from using you as a CMV driver.

Applicant Signature(*)

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Date(*)

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Applicant Email address(*)

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This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. We are an equal opportunity employer

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Maynard's Electric

APPLICANT INFORMATION

Maynard's Electric Employment Application

EDUCATION

REFERENCES

PREVIOUS EMPLOYMENT

Licenses-Skills-Certifications

DISCLAIMER AND SIGNATURE

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