Application

Jess Howard Electric Company
Application For Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veterans status, or any other legally protected status.

Position(s) Applied For			Date
Last Name	First Name		Middle Name
Address	City	State	Zip Code
Telephone Number(s)
Best time to contact you at home is:

Please check yes or no for the following questions below.		Yes	No
If you are under 18 years of age, can you provide required proof of your eligibility to work?
Have you ever filed an application with us before? If yes, give date_________
Have you ever been employed with us before? If yes, give date ___________
Do any of your friends or relatives, other than spouse, work here? If yes, state name, relationship and location________________________
Are you currently employed?
May we contact your present employer?
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.
Date available for work___/____/____	What is your desired salary range? ______________
Are you available to work:(Circle appropriate response) Full Time (Please indicate 1 2 3 shift) Part Time (Please indicate Morning Afternoon Evenings) Temporary (Please indicate dates available___/___/___
Are you currently on "lay-off" status and subject to recall?
Can you travel if a job requires it?

Education

School	Name and Address of School	Course of Study	No. of Years Completed	Diploma/Degree
High School
Undergraduate College
Graduate/ Professional
Other (Specify)

Work Experience

Start with present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer	Dates Employed		Work Performed
Address	From	To
Telephone Number(s)
Starting/Present Job Title	Hourly Rates/Salary
Supervisor	Starting	Final
Reason for Leaving
May we contact Yes/No

Employer	Dates Employed		Work Performed
Address	From	To
Telephone Number(s)
Starting/Present Job Title	Hourly Rates/Salary
Supervisor	Starting	Final
Reason for Leaving
May we contact Yes/No

Employer	Dates Employed		Work Performed
Address	From	To
Telephone Number(s)
Starting/Present Job Title	Hourly Rates/Salary
Supervisor	Starting	Final
Reason for Leaving
May we contact Yes/No

Employer	Dates Employed		Work Performed
Address	From	To
Telephone Number(s)
Starting/Present Job Title	Hourly Rates/Salary
Supervisor	Starting	Final
Reason for Leaving
May we contact Yes/No

Comments: Include explanation of any gaps in employment

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

Describe any job-related training received in the United States military.

List professional, trade, business or civic activities and offices held
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:

Additional Information

Other Qualification- Summarized special job-related skills and qualifications acquired from employment or other experience.

Please state any Specialized Skills (Skills/Equipment Operated)

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activates involved in the job or occupation for which you have applied? A review of the activates involved in such a job or occupation has been given.
___Yes ___No

Personal/Professional References
Do not include family members or past supervisors.

Name	Phone Number	Best Time to Call	Occupation
1.
2.
3.

Applicant's Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time with or without cause. It is future understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand, that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Signature of Applicant______________________________________________ Date__________________

Pre-Employment Consent Form For Substance Testing I hereby voluntarily consent to allow the Company to collect blood and urine specimens from me for testing for alcohol, drugs and controlled substances, by an approved doctor or laboratory. Further, I give my consent for the release of the test results to the appropriate members of the Company's management. I understand that any positive result will preclude my employment. Applicants who refuse to sign this consent will not be considered for employment.
_________________________	_________________________
Date	Signature