Employment Application - California Industrial Electric Corporation

Step 1. Personal Information

Full Name:

Address:

Mailing Address:

Phone Number:

Email Address:

Position Applying For:

Salary Requested:

Will you travel if the job requires it?

Have you been convicted of a felony in the last (7) years?

Referral Source:

Step 2. Licensing

Drivers License #:

Drivers License State of issue:

Drivers License Expiration Date:

Have you had any accidents in the past 3 years?

Are you a licensed contractor? If yes, license #:

Are you legally eligible for employment in this country?

Are you in an electrical apprentice program?

Are you listed with the State of California as a Trainee? If so please, what is your Trainee number?

Are you a certified journeyman? If yes, #:

If no, are you scheduled to take the Journeyman's Certification test? Please provide test date:

Step 3. Education/Language

Name and Location (#1):

Years Attended (#1):

Diploma/Degree (#1)?

Name and Location (#2):

Years Attended (#2):

Diploma/Degree (#2)?

Name and Location (#3):

Years Attended (#3):

Diploma/Degree (#3)?

Language (#1):

Speak Read Write

Language (#2):

Speak Read Write

Language (#3):

Speak Read Write

Step 4. Additional Skills Or Qualifications

Step 5. References

Name (#1):

Phone Number (#1):

Years Known (#1):

Relationship (#1):

Name (#2):

Phone Number (#2):

Years Known (#2):

Relationship (#2):

Name (#3):

Phone Number (#3):

Years Known (#3):

Relationship (#3):

Name (#4):

Phone Number (#4):

Years Known (#4):

Relationship (#4):

Step 6. Last 4 Employers Starting With The Most Recent

Employer (#1):

Address (#1):

Job Title (#1):

Dates Employed (#1):

mm/dd/yyyy - mm/dd/yyyy

Rate of Pay (#1):

Reason for Leaving (#1):

May we contact for a reference? (#1)

Responsibilities (#1):

Employer (#2):

Address (#2):

Job Title (#2):

Dates Employed (#2):

mm/dd/yyyy - mm/dd/yyyy

Rate of Pay (#2):

Reason for Leaving (#2):

May we contact for a reference? (#2)

Responsibilities (#2):

Employer (#3):

Address (#3):

Job Title (#3):

Dates Employed (#3):

mm/dd/yyyy - mm/dd/yyyy

Rate of Pay (#3):

Reason for Leaving (#3):

May we contact for a reference? (#3)

Responsibilities (#3):

Employer (#4):

Address (#4):

Job Title (#4):

Dates Employed (#4):

mm/dd/yyyy - mm/dd/yyyy

Rate of Pay (#4):

Reason for Leaving (#4):

May we contact for a reference? (#4)

Responsibilities (#4):

Step 7. Attach Your Resume

Step 8. Please Read Carefully

In exchange for the consideration of my job application by California Industrial Group Corporation (hereinafter called "the Company"), I agree that:

a. It is understood that any misrepresentation or omission of facts by me on this application will be sufficient cause for cancellations of this application and/or separation from the Company if I have been employed.

b. This application is current for only 60 days. At the conclusion of this time, if I have not heard from the Company and still wish to be considered for employment, it will be necessary to fill out a new application.

c. I authorize investigation of all statements contained in this application. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and other, and hereby release the Company from any liability as a result of such contacts.

This Company is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualification.

This Company requires and pays for drug testing prior to and during employment. Submission of this application is your acknowledgment and acceptance of this requirement.

I Agree I Don't Agree

Application for Employment