APPLICANT INFORMATION
Name:
Address:
City:
State:
Zip:
Phone:
Alternate Phone:
Email:
Date of Birth:
Driver's License Number/State:
EMPLOYMENT INFORMATION
Position Applying For:
Hours & Days Available:
Date Available to Start:
Can you work the following?
Desired Salary:
Have you applied with us before?
If so, approx. what date?:
PERSONAL INFORMATION
Do you have friends or relatives working with us?
If yes, who and what relation?:
Do you have your own transportation?
If hired, are you willing to submit and pass a drug test?
Are you able to perform the essential duties of the job?
If no, explain:
Have you been convicted of ANY crime?
If yes, explain:
List three (3) personal references and phone numbers
#1 Personal Reference/Phone:
#2 Personal Reference/Phone:
#3 Personal Reference/Phone:
List any special skills, certifications, qualifications, etc. that you have:
EMPLOYMENT HISTORY
Employer #1
#1 Employer Name:
#1 Employer Address:
#1 Last Salary:
#1 Supervisor/Phone Number:
#1 Position:
#1 Duties and Job Description:
#1 Dates To/From:
#1 Reason for Leaving:
Employer #2
#2 Employer Name:
#2 Employer Address:
#2 Last Salary:
#2 Supervisor/Phone Number:
#2 Position:
#2 Duties and Job Description:
#2 Dates To/From:
#2 Reason for Leaving:
Employer #3
#3 Employer Name:
#3 Employer Address:
#3 Last Salary:
#3 Supervisor/Phone Number:
#3 Position:
#3 Duties and Job Description:
#3 Dates To/From:
#3 Reason for Leaving:
May we contact your current employer?
EDUCATION HISTORY
High School Attended:
High School Address (City, State, and Zip):
High School Dates To/From:
Did you graduate high school?
College Attended:
College Address (City, State, and Zip):
College Dates To/From:
College Major:
Did you graduate college?
MILITARY HISTORY
Did you serve in the military?
If yes, what branch, rank, and number of service years:
By submitting your application, you are electronically certifying the information contained within is accurate and true to the best of your knowledge. We reserve the right to verify any information contained within. Thanks for your interest in Security Plus Electrical.
