Job Application Form

Full Name:*

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Please Enter First Name

Please Enter M.I.

Address:*

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Please Enter Apartment/Unit #

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Phone:*

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Email:*

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Date Available:*

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Desired Salary:*

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Position Applied for:*

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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.?

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Have you ever worked for this company?*

Please Enter Have you ever worked for this company?

If yes, when?

Have you ever been convicted of a felony?*

Please Enter Have you ever been convicted of a felony?

If yes, explain:

Please Explain

High School:*

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Address:*

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Date:*

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Did you graduate?*

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College:

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Address:

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Date:

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Did you graduate?

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Degree:

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Other:

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Address:

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Date:

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Did you graduate?

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Degree:

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Do you have a valid driver’s license?*

Please Enter Degree

Do you have a clean driving record?*

Please Enter Do you have a clean driving record?

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

Please Enter reliable transportation to work

Type

Operator Commercial (CDL)

Branch:

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Date:

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Rank at Discharge:

Please Enter Rank at Discharge

Type of Discharge:

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If other than honorable, explain:

Please Enter Type of Discharge

Company:*

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Phone:*

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Address:*

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Supervisor:*

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Job Title:*

Please Enter Job Title

Please Enter Starting Salary:*

Starting Salary

Ending Salary:*

Please Enter Ending Salary

Responsibilities:*

Please Enter Responsibilities

Date:*

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Please Enter To

Reason for Leaving:*

Please Enter Reason for Leaving

May we contact your previous supervisor for a reference?*

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Company:

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Phone:

Please Enter Phone

Address:

Please Enter Address

Supervisor:

Please Enter Supervisor

Job Title:

Please Enter Job Title

Starting Salary:

Please Enter Starting Salary

Ending Salary:

Please Enter Ending Salary

Responsibilities:

Please Enter Responsibilities

Date:

Please Enter From

Please Enter To

Reason for Leaving:

Please Enter Reason for Leaving

May we contact your previous supervisor for a reference?

Please Enter May we contact your previous supervisor for a reference?

Company:

Please Enter Company

Phone:

Please Enter Phone

Address:

Please Enter Address

Supervisor:

Please Enter Supervisor

Job Title:

Please Enter Job Title

Starting Salary:

Please Enter Starting Salary

Ending Salary:

Please Enter Ending Salary

Responsibilities:

Please Enter Responsibilities

Date:

Please Enter From

Please Enter To

Reason for Leaving:

Please Enter Reason for Leaving

May we contact your previous supervisor for a reference?

Please Enter May we contact your previous supervisor for a reference?

What types of systems have you worked with? (Select all that apply)

What types of wiring have you worked with? (Select all that apply)

110

220

4160

480

Cat5/Cat6

Coax

Fiber Optic

What specific parts, accessories, or fixtures have you worked with? (Select all that apply)

What applications do you have experience with? (Select all that apply)

What job functions have you performed?

What computer related experience do you have? (Select all that apply)

What certifications & licenses do you have? (Select all that apply)

Apprentice Electrician License

Journeyman Electrician License

Master Electrician License

Registered Professional Engineer

Other certifications & licenses held:

Use the space below to 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.

Please list three professional references. Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship:

Company: Phone:

Address:

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 Reynolda Electric Co, Inc. creates an actual or implied contract of employment. I understand that, if I accept employment with Reynolda Electric Co, Inc., it will be on an at-will basis. This means that either Power Systems Electric Corporation 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 Reynolda Electric Co, Inc. I release Reynolda Electric Co, 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 Reynolda Electric Co, 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 Reynolda Electric Co, Inc. and its employees from all liability arising from such investigation.

Job Application Form

Personal Information

Education

Driver’s License & Transportation Information

Military Service

Work Experience

Electrical Industry Skills

Certifications & Licenses

Additional Information

References

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