Apply Online * fields are required. Personal Information + Date*03/05/2021 First Name* Middle Initial and Last Name Phone Number* (example: 555-555-5555) Secondary Phone Number (example: 555-555-5555) Email* (example: myname@example.com) Referred By Present Address* City, State and Zipcode* (example: Navarro Victoria, TX 77904) Permanent Address* City, State and Zipcode* (example: Navarro Victoria, TX 77904) Employment Desired + Position* Date you can start* (example: 01/01/2017) Salary desired* Are you employed now?*YesNo May we inquire of your present employer?*YesNo Have you ever applied to this company before?*YesNo Where When (example: 01/01/2017) Education History + High School Location Years Attended Did you graduate?YesNo Subjects Studied College Location Years Attended Did you graduate?YesNo Subjects Studied Trade, Business, or Correspondence School Location Years Attended Did you graduate?YesNo Subjects Studied General Information + Subject of special study/research work Special training Special skills US Military or Naval service Rank Former Employers + List below your last four employers, starting with the last one first. Company Address City, State and Zipcode (example: Navarro Victoria, TX 77904) Dates of Employment to (example: 01/01/2017) Salary Position Reason for leaving Company Address City, State and Zipcode (example: Navarro Victoria, TX 77904) Dates of Employment to (example: 01/01/2017) Salary Position Reason for leaving Company Address City, State and Zipcode (example: Navarro Victoria, TX 77904) Dates of Employment to (example: 01/01/2017) Salary Position Reason for leaving Company Address City, State and Zipcode (example: Navarro Victoria, TX 77904) Dates of Employment to (example: 01/01/2017) Salary Position Reason for leaving References + Name Business Years Known Address City, State and Zipcode (example: Navarro Victoria, TX 77904) Name Business Years Known Address City, State and Zipcode (example: Navarro Victoria, TX 77904) Name Business Years Known Address City, State and Zipcode (example: Navarro Victoria, TX 77904) Pre-employment Questionaire + Do you have a Texas state electrical license?*YesNo Can you pass a Drug Test / Physical?*YesNo Do you have a driver's license and good driving record?*YesNo Can you work a 40 hour work week?*YesNo Do you have 5 years experience?*YesNo Can you troubleshoot?*YesNo Can you do new installs / rework?*YesNo Do you have good communication skills?*YesNo Do you have a criminal record?*YesNo If yes, please explain Authorization + "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment." 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. Date*03/05/2021 Signature*