Application

Unique ID

THIS APPLICATION IS VALID FOR 45 DAYS ONLY AND WILL NOT BE CONSIDERED AFTER 45 DAYS. IF YOU ARE STILL INTERESTED IN EMPLOYMENT AFTER 45 DAYS, YOU MUST REAPPLY AND FILL OUT A NEW APPLICATIONS.

Electrical Systems Company, LLC

APPLICATIONS FOR EMPLOYMENT

Electrical System Company, LLC is an equal opportunity employer. Electrical System Company, LLC seeks and employs qualified persons in all job classifications and positions without discrimination on the basis of a qualified applicant's race, color, religion, sex, age, disability, national origin, citizenship, veteran status or any other characteristic protected by state or federal law.

Personal Information

Name*

First Middle Last

Phone*

Permanent Address*

Street Address Address Line 2 City State ZIP Code

Current Address*

Street Address Address Line 2 City State ZIP Code

Are you over the age of 18?*

Are you legally eligible for employment in the U.S.?*

Who referred you to us?*

Employment Desired

Position Desired*

Starting Wage Desired*

Date You Can Start?*

Are You Currently Employed?*

If so, may we contact your present employer?*

Have you applied for employment here before?*

If yes, when?

Have you ever been employed here before?*

If yes, when?

What was your reason for leaving?*

Do you know or are you related to anyone who works for this Company?*

If yes, please identify who and the nature of the relationship.

Education

1. Name Of School*

Address*

City State

Main Course of Study*

Did You Graduate?*

Grade Average

Degree*

2. Name Of School

Address

City State

Main Course of Study

Did You Graduate?

Grade Average

Degree

3. Name Of School

Address

City State

Main Course of Study

Did You Graduate?

Grade Average

Degree

4. Name Of School

Address

City State

Main Course of Study

Did You Graduate?

Grade Average

Degree

Are there any other job related experiences, skills, or qualifications which will be of special benefit in the job for which you are applying?*

Employment History

(List prior employment, starting with present job. You must fill out completely all information requested below.)

1. Company Name*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Job Title*

Supervisor*

First Last

Dates Employed (From - To)*

Salary/Wage*

Specific Duties*

Reason For Leaving*

2. Company Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Job Title

Supervisor

First Last

Dates Employed (From - to)

Salary/Wage

Specific Duties

Reason For Leaving

3. Company Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Job Title

Supervisor

First Last

Dates Employed (From - to)

Salary/Wage

Specific Duties

Reason For Leaving

4. Company Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Job Title

Supervisor

First Last

Dates Employed (From - to)

Salary/Wage

Specific Duties

Reason For Leaving

References

List 2 people not related to you who have known you for at least 1 year

1. Reference's Name*

First Last

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Business*

Years Acquainted*

2. Reference's Name*

First Last

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Business*

Years Acquianted*

Employment Limitations

Have you been told the essential functions of the job or have you been shown a copy of the job description listing the essential functions of the job?*

If yes, can you perform the essential functions of the job with or without reasonable accommodation?*

Please Read Before Signing

I certify that all the information provided on this employment application is true, correct, complete, and without material omission. I understand that omissions or misrepresentation of any information provided or requested will be grounds for withdrawal of my application from further consideration for employment, or termination of my employment if the omission or misrepresentation is discovered after hire. I agree that Electrical Systems Company, LLC shall not be held liable in any respect if a job offer is not extended, is withdrawn or my employment is terminated because of false statements, omissions or answers made by me on this application. Employment by Electrical Systems Company, LLC may be conditioned upon my passing physical tests and examinations, including specimen, reflex, and range analysis, and if employed, upon passing such tests and examinations from time to time as requested by the Company in accordance with state and federal laws. By submitting this application, or submitting to such tests, I hereby authorize any doctor, hospital, clinic, or laboratory conducting said test and examinations to release the results and any other information necessary for Electrical Systems Company, LLC to determine my ability to perform the job I am being considered for or, if employed, performing. I understand that, as allowed by applicable state law, if during the application process, including the medical examination, I knowingly and willfully make a false representation regarding my physical condition and Electrical Systems Company, LLC relies on my misrepresentation, I may forfeit my workers compensation benefits if I am injured on the job and there is a direct link between the false representation and my injury. Should I decide to accept employment with Electrical Systems Company, LLC, I authorize the company or any agent of the company to search any locker assigned to me, my clothing, personal possessions and my personal vehicle while on Company or client's property, when deemed necessary by Electrical Systems Company, LLC for security or safety reasons. I hereby authorize any person, agency, current employer or its agents, former employer or its agents, school, trade school, college, or university to release any and all information and or records pertaining to or otherwise relating to my employment, application for employment, education, or training in the possession, custody, or control of such person, agency, current or former employer, school, trade school, college, or university. Further, I voluntarily and knowingly release any person, agency, current or former employer, school, trade school, college, or university from any and all claims, damages, or liabilities whatsoever for releasing any or all such information in their possession, custody or control to Electrical Systems Company, LLC, or its agent or agents. If I am employed with Electrical System Company, LLC, I will comply with all the rules and regulations as set forth in any communication distributed to employees. I understand that part of the application process may include submitting to a drug test to determine the use of illegal drugs. I understand that positive findings will result in immediate disqualification and the removal of my name for consideration for the position for which I am applying. I hereby agree to submit to such tests and release the results to Electrical System Company, LLC. In compliance with the Immigration Reform and Control Act of 1986, I understand that I will be required to provide approved documentation that verifies my right to work in the United States upon employment. I further understand and agree that my employment is for no definite period and may, regardless of the date of payment of wages or salary, be terminated for any reason and at any time without previous notice by the Company or me. I understand that I have been hired contingent on my successful completion of a background check, drug screen, and physical examination. Although I have successfully completed a field drug test, I acknowledge that the field drug test given to me is not determinative of my employment with Electrical Systems Company, LLC. I acknowledge that no employment contract has been created. I further acknowledge that no statements or action have been made that I could construe to create any contract of employment either express or implied, including, without limitation, any contract of employment for a definite duration. Employment with Electrical Systems Company, LLC is at-will and may be terminated by either the company or by myself at any time. Written or oral statements made to me are not to be interpreted in any way that alters the at-will relationship. I hereby acknowledge that I have read and understand the above statements.

Signature*

Date*

Military Information

Have you ever served in the military?*

Branch of service

Date of service (From - To)