Help Wanted

 

Application For Employment

 All fields marked with an * must be filled out.

PLEASE FILL OUT THIS FORM, PRINT IT AND FAX IT TO US AT (603) 798-5597

   
 Position Applied for   *    Job Code 
   
 
Contact Information
   
 Email Address    
   
 Last Name   *
   
 First Name   *      Middle Name  
   
 Current Address   *    City   *
   
 State   *     Zip   *
   
 Home Phone Number   *       Other Phone Number  
   
 
Valid Driver's License
   
 License Number   *      State   *      Expiration Date   *

  Operator's         CDL Class  
   
 
Education and Training
SCHOOL (include vocational/technical and COLLEGE)          Highest grade completed: *
   
 School Name         Years Attended  
   
 Location (City/State)              Credit Hours  
   
 Degree Earned         Major Field of Study  
   Did You Graduate?    Yes    No
   
 School Name         Years Attended  
   
 Location (City/State)              Credit Hours  
   
 Degree Earned         Major Field of Study  
   Did You Graduate?    Yes    No
   
 School Name         Years Attended  
   
 Location (City/State)              Credit Hours  
   
 Degree Earned         Major Field of Study  
   Did You Graduate?    Yes    No
   
 
Employment History
List all jobs held in the last TEN years plus any other employment as it relates to the position for which you are applying. Major changes in duties or job titles with the same employer should be listed separate jobs. Start with your present or most recent position and work back. Be specific -- your rating may depend on the information your provide.
   
 Present or most recent
 Employment		            Job Title  
   
 Address  
   
 Supervisor's Name/Title         Telephone  
   
   From: Month    Year  
    To: Month    Year    Total Time:  Yrs.     Mos.   

 Hrs per wk   Starting Sal. $  per   Last Sal. $  per

   
 Reason for leaving  
   
 Duties  
   
 Previous Employment           Job Title  
   
 Address  
   
 Supervisor's Name/Title          Telephone  
   
   From: Month    Year  
    To: Month    Year    Total Time:  Yrs.     Mos.   

 Hrs per wk    Starting Sal. $  per   Last Sal. $  per

   
 Reason for leaving  
   
 Duties  
   
 Previous Employment           Job Title  
   
 Address  
   
 Supervisor's Name/Title          Telephone  
   
   From: Month    Year  
    To: Month    Year    Total Time:  Yrs.     Mos.   

 Hrs per wk    Starting Sal. $  per   Last Sal. $  per

   
 Reason for leaving  
   
 Duties  
   
 Previous Employment           Job Title  
   
 Address  
   
 Supervisor's Name/Title          Telephone  
   
   From: Month    Year  
    To: Month    Year    Total Time:  Yrs.     Mos.   

 Hrs per wk    Starting Sal. $  per   Last Sal. $  per

   
 Reason for leaving  
   
 Duties  
   
 
REFERENCE
List (3) personal reference who are not relatives or former employers.
   
 Name           Occupation  
   
 Address      Phone      Yrs. Known  
   
 Name           Occupation  
   
 Address      Phone      Yrs. Known  
   
 Name           Occupation  
   
 Address      Phone      Yrs. Known  
   
 *Have you ever been employed by the Harry O Electrical Corp? Yes No
       If yes, give dates and department

 
 *Have you ever been convicted of any criminal offense, pleaded guilty or nolo contendere,
   or found guilty of criminal offense, even though adjudication was withheld or sentence
   was suspended?  Yes No

          Date                        Charge
        Place    Current Status

   (NOTE: A "yes" response to this question does not automatically disqualify you for employment).

 
 *Have you ever been defendant in any civil action or lawsuit that included a claim against
   you for a intentional tort (including but not limited to assault, battery, false imprisionment,
   negligent or intentional inflection of distress, trespass, etc?)  Yes No

      If yes, state the date, name and location of the court in which the claim, action, or lawsuit
      was brought against you, and the current status or disposition of the claim, action or lawsuit.

        Date         Court(name/location)

        Status/disposition
 
 
How did you hear of this opening?
  An Employee Web Page
  Job Announcement Board Newspaper Ad - Specify Newspaper
  Employment Agency Other
 
*APPLICANT CERTIFICATION - READ CAREFULLY: I here by certify that I have a sincere interest in obtaining this position and that each answer to questions herein and all other information otherwise furnished is true and correct. I understand that any incorrect, incomplete, or false statements of information furnished may subject me to disqualification or discharge at any time.
    Agreed      Disagree
 
Please explain how your experience relates to the position for which you are applying.
(You may paste your resume here)
 
PLEASE FILL OUT THIS FORM, PRINT IT AND FAX IT TO US AT (603) 798-5597
 
     
 
 
© 2004 Harry-O Electrical