Employment Employment Application All fields that have an * must be completed in order for this application to be processed. employment I. PERSONAL INFORMATIONName* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Cell PhoneEmail* Have you been known by any other name that an IECA member may require to verify information regarding your application?* Yes No If yes, please identify name: Rate of pay or salary you are seeking: Other benefits you are seeking: Briefly describe your experience in the electrical field*(e.g. commercial, residential, industrial, years of experience, etc.)List skills you possess that will be relevant to position sought:* Are you over the age of eighteen (18)?* Yes No Are you eligible for employment under the immigration laws of the United States?* Yes No When are you available to work?* Full Time Part Time Temporary Work Overtime If any limitations to availability, please explain: Do you have dependable transportation?* Yes No If yes, what kind? Do you have a valid driver's license?* Yes No Driver's License # and State: (Will collect at office)Have you been convicted of a felony within the last 7 years? (Conviction will not necessarily disqualify you from employment.)* Yes No If yes, please explain:II. Employment HistoryYour application will not be considered unless this section is answered. Since previous employers may be contacted, correct information about your past employment is critical. You should include Military Service assignments.Are you currently employed?* Yes No If no, how long since last employment? CURRENT EMPLOYER:If you are currently employed (part time or full time), complete the following:Company Name: Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State PhoneDates employed from: ex. ( 01/01/2015 - 01/01/2016)Job title: Supervisor's Name: First Last Duties: Salary: Per-hour? Reason for Leaving? If terminated, what reason was given to you? Will you resign your current employment if hired by an IEC member?* Yes No If not, or if uncertain, explain:* 1. Prior EmployersCompany Name: Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State PhoneDates employed from: ex. ( 01/01/2015 - 01/01/2016)Job title: Supervisor's Name: First Last Duties: Salary: Per-hour? If terminated, what reason was given to you? Reason for Leaving? 2. Prior EmployersCompany Name: Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State PhoneDates employed from: ex. ( 01/01/2015 - 01/01/2016)Job title: Supervisor's Name: First Last Duties: Salary: Per-hour? Reason for Leaving? If terminated, what reason was given to you? 3. Prior EmployersCompany Name: Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State PhoneDates employed from: ex. ( 01/01/2015 - 01/01/2016)Job title: Supervisor's Name: First Last Duties: Salary: Per-hour? Reason for Leaving? If terminated, what reason was given to you? III. ADDITIONAL INFORMATIONAre you a user of intoxicating drugs or alcohol? Yes No If yes, please explain:Based on your opinion of yourself & your previous employment, what type of employee will you be, regarding:Attendance: Responsibility: Attitude: Conscientiousness: IV. EDUCATIONAL INFORMATIONHigh School Graduate?* Yes No GED Last School Attended? Attend College? Yes No Name of College? # of credit hours: Years Attended: Dates: Have you taken courses in the following subjects? If so, specify the number of years/credit hours in each:Electricity Physics Algebra Drafting Have you attended a vocational training course? Yes No If so, which craft? Name of School: Years attended: ex. (01/01/2015-01/01/2016)Have you have served an apprenticeship? Yes No If so, which craft? Years attended: ex. (01/01/2015-01/01/2016)Name of Sponsoring Organization: Are you a Licensed Electrician? Yes No Master Journeyman Apprentice Where? License # Is license current? Yes No # years of experience: IMPORTANT INFORMATION AND CONDITIONSBy clicking the acceptance button, I certify that all statements contained in this application or mad in conjunction with it are true and correct, and any misrepresentation or omission of facts called for is grounds for rejection of my Application (or will result in dismissal should I be employed) whenever the correct information becomes known to Tilmann Electric, Inc.* I accept the terms and conditions Name* First Last Date* MM slash DD slash YYYY RELEASE-AUTHORIZATION FOR INFORMATIONBy clicking the acceptance button, I do hereby authorize a review and full disclosure of all records concerning myself. I authorize Tilmann Electric, Inc. and its representatives the right to investigate all references and the right to secure consumer reporting, or other agencies, including but not limited to, criminal history and motor vehicle driving records. Furthermore, I authorize all my current and former employers, school officials, instructors, licensing board(s), reporting agencies, or any other person whether or not named in my application to release an information they may have regarding me, whether or not such information is in their written records; and I hereby release all persons, schools, companies, and law enforcement authorities from any damage whatsoever for issuing this information. A copy of this release form will be valid as an original thereof, even thought the said internet form submission does not contain an original writing of my signature.* I accept the terms and conditions Name* First Last Date* MM slash DD slash YYYY Δ
