- Legacy Electrical Services, Inc.

GENERAL

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Position applied for *

Full Legal Name *

Address *

City / State / Zip *

Department *

Home Phone # *

Cell Phone # *

Email Address *

EDUCATION

Check highest grade completed *

If you did not complete high school, do you have a high school equivalency diploma? *

Yes
No

Check number of years of post-high school education *

Post high school education (include college / university / trade / technical / other)

Institution Name/City

Major/Specialty

Dates Attended

Hrs/Degree

Minor

Institution Name/City

Major/Specialty

Dates Attended

Hrs/Degree

Minor

Institution Name/City

Major/Specialty

Dates Attended

Hrs/Degree

Minor

If you expect to complete an education program in the near future, indicate what type of degree or program and expected completion date. *

REFERENCES Include only those who know your qualifications

Name *

Address *

Phone *

Relationship *

Name

Address

Phone

Relationship

Name

Address

Phone

Relationship

OFFICE SKILLS Computer related (if applicable to the position to which you are applying) *

Other:

ADDITIONAL INFORMATION

Use this space for any additional information you think would help us evaluate your application, including training seminars, workshops, and special achievements or specialized skills:

EXPERIENCE If you are attaching or have sent a resume, you do not need to complete this section

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Job Title: *

Duties: *

Employer: *

Address: *

City / State: *

Phone *

Type of Business: *

Start / End Salary: *

Start / End Employment Dates: *

# of Employees You Supervised: *

Equipment used: *

Reason for leaving: *

Full Time
Part Time

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Job Title:

Duties:

Employer:

Address:

City / State:

Phone

Type of Business:

Start / End Salary:

Start / End Employment Dates:

# of Employees You Supervised:

Equipment used:

Reason for leaving:

Full Time
Part Time

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Job Title:

Duties:

Employer:

Address:

City / State:

Phone

Type of Business:

Start / End Salary:

Start / End Employment Dates: (copy)

# of Employees You Supervised:

Equipment used:

Reason for leaving:

Full Time
Part Time

MISCELLANEOUS

For purpose of compliance with The Immigration Reform and Control Act, are you legally eligible for employment in the United States? *

Yes
No

Under the Immigration Reform and Control Act of 1986, you will be required to fill out a certification verifying that you are eligible to be employed and verifying your identity. Further, you will be required to provide documentation to that effect should you be employed.

Have you ever been convicted of a felony or misdemeanor? *

Yes
No

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If yes, in what state?

Describe:

When will you be available to start work? *

I hereby certify that all entries on both sides and attachments are true and complete. I agree and understand that any falsifications of information herein, regardless of time of discovery, may cause forfeiture on my part of any employment in the service of Legacy Electrical Services, Inc. I understand that all information on this application is subject to verification and I consent to a criminal history background check and drug testing prior to employment.

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Date

Signature

Application For Employment

GENERAL

EDUCATION

MISCELLANEOUS