Application

Date *

Position Applied For *

Other

Full Name *

First

Last

Phone Number *

Date Available To Work *

Email *

example@example.com

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How long have you lived at current address? *

Do you have family or close friends who are currently employed by S. Clark Electric? *

Yes
No

If so, please list names of family or close friends who are currently employed by S. Clark Electric.

Do you have a commercial driver's license (CDL)? *

Yes
No

Class of License

Driver's license number *

State Issued *

Date of Expiration *

Restrictions *

To the best of your knowledge, is your drivers license valid at this time? (i.e. not under suspension?) *

Yes
No

Do you have any certifications? *

Yes
No

Certification

If other, explain.

Certification Expiration Date

List any State Electrical License that you hold, license number, and expiration date. *

Are you currently employed? *

Yes
No

Does your present employer know of your plans to change employment? *

Yes
No

Can we contact your current or previous employers? *

Yes
No

If no, which of your previous employers should we not contact?

Why do you desire to make a change?

Have you ever been discharged or asked to resign? *

Yes
No

Do you use illegal drugs? *

Yes
No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment. *

Yes
No

Have you ever been convicted of a crime, pled no contest, or had adjudication withheld? *

Yes
No

If yes, explain.

Are you currently on "Lay-off" status and subject to recall? *

Yes
No

Are you currently in the National Guard or Reserves? *

Yes
No

Are you willing to travel when the job requires it? *

Yes
No

The highest educational grade completed. If college or line school, list college name and level of degree.

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Previous Employment

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Supervisor's Name *

First

Last

Your Job Title

Start Date

End Date

Ending Salary

Reason For Leaving

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Supervisor's Name *

First

Last

Your Job Title

Start Date

End Date

Ending Salary

Reason For Leaving

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Supervisor's Name *

First

Last

Your Job Title

Start Date

End Date

Ending Salary

Reason For Leaving

References

Name *

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Position Held

Name *

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Position Held

Previous Employment

References

Office

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