Application for Employment

Empire Electric M&S, Inc. is currently accepting applicants to fill available positions.

To ensure proper consideration, please fill in the information below as completely and accurately as possible.

Personal Information

First Name *

Last Name *

Address 1 *

City *

State *

Zip Code *

Phone *

Email Address *

Have you ever applied for employment or been employed by this Company? *

Yes

Referred By *

Position Applying For *

Date Available *

How much are you expecting to be paid according to your experience, knowledge and job market conditions? *

Have you ever been convicted of a felony within the last 7 years? *

Yes

If yes, please explain.

Do you smoke?

Yes

Are you legally authorized to work in the United States? *

Yes

Are you willing to take a drug test if required as part of your application? *

Yes

If a favorable hiring decision is made, will you submit to a medical examination and/or answer a medical questionnaire after a hiring decision is made? *

Yes

Availability

Will you work overtime or shift work? *

Yes

Employment History

Employer 1

Company Name

Address

Phone

Start Date +

End Date +

Position

Salary

Supervisor/Manager

Reason for Leaving

May we contact? *

Yes

Phone Number

Are you currently working for this employer? *

Yes

Employer 2

Company Name

Address

Phone

Start Date +

End Date +

Position

Salary

Supervisor/Manager

Reason for Leaving

May we contact? *

Yes

Phone Number

Employer 3

Company Name

Address

Phone

Start Date +

End Date +

Position

Salary

Supervisor/Manager

Reason for Leaving

May we contact? *

Yes

Phone Number

References

Reference 1

Name

Title

Email Address

Phone

Reference 2

Name

Title

Email Address

Phone

Reference 3

Name

Title

Email Address

Phone

Additional Skills

Do you have a valid driver's license? *

Yes

D.L. #

Do you hold a journeyman or master electrician license or any other electrician license with any state, country or municipality? *

Yes

If Yes, please list:

List any additional skills that you would like to mention.

Have you had safety training for electrical work? *

Yes

Please submit a copy of your resume.

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