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Name
Address
City
State
Phone
Todays date
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Are you at least 18 years of age
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If you are under 18 state your age
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Have you ever worked for this Company before?
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If yes, when and for how long
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ZIP
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Position for which you are applying:
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Other positions for which you would like to be considered:
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Salary Expected:
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What experience or skills qualify you for work here?
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Previous work history
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Name and Address of Employer
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Dates worked
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May we
contact this
company
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Ending wage
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Reason for leaving
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Job Title or Duties
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Phone
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Supervisors Name
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Phone
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Supervisors Name
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Supervisors Name
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Phone
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Phone
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Supervisors Name
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Education History
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Schold name and address
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Last Year Completed
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Degree or Studies
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High School
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College
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Trade School
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Personal References (Do not use former employers or relatives)
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Name, Address, Telephone Relationship and Years Known
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May we contact your references?
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The normal working hours of the Company vary and encompass different shifts, including Saturdays. Without
indicating the need for any absences for religious practices during the normal working hours, are you otherwise
available to work during these hours?
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Have you served an apprenticeship
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If yes, how many years and what Trade
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If your application is considered favorably, on what date can you begin work?
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Are you willing and able to travel?
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If no, why not
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Do you own a vehicle?
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Make, Model and Year
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Will you be able to drive for the Company?
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If no, why not
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How is your driving record?
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Would you submit to a drug test?
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PLEASE READ THE LANGUAGE BELOW CAREFULLY, SHOULD YOU HAVE ANY QUESTIONS
REGARDING THIS LANGUAGE, PLEASE SEEK ASSISTANCE PRIOR TO SIGNING THIS DOCUMENT.
I certify that the information contained in this application is true, accurate and complete. I understand that falsification of the Employment
Application in any detail may result in disqualification from further consideration, or if hired, immediate dismissal without notice and
ineligible for reemployment. As a condition of employment, I understand the Company reserves the privilege to thoroughly investigate
(background check) and verify all information contained in this Employment Application, including but not limited to contacting any of the
above mentioned employers, supervisors, and references. I agree to indemnify and save the Company from and against any liabilities,
claims, attorneys fees, costs, causes of action or other liability arising directly or indirectly from, or associated with this Employment
Application.
I agree to conform to the rules and regulations of the Company, and I understand that my employment and compensation can be
terminated, without cause, at any time, at the option of either the Company or myself. I further understand that no personnel recruiter or
interviewer or other representative of the Company, other than it's President or Vice President has any authority to enter any agreement
for employment for any specified period of time, or to make any agreement contrary to the foregoing.
If I am hired on a full-time basis, I agree to work only for Palazzo Brothers Electric, Inc. and will not be employed by any other employer(s).
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Date
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Please retype your name here as your signature
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