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Pre-Employment Application

Name:
Social Security Number:
Address:
City, State, Zip Code:
Phone Number:
Mobile, Beeper, Other:
Are you legally eligible for employment in this country?
Yes No
Do you Smoke?
Yes No
Have you been convicted of any crime, including driving while under the influence of alcohol? Yes No

If "Yes", please explain:

Note: A conviction will not necessarily disqualify you from employment.

Are you able to meet the attendance requirements for the position? Yes No
Are you willing to travel? Yes No
Drivers License: State & Number:
License Type:
Currently Valid? Yes No

Employment Desired

Position(s) applied for:
Desired Salary:
Type of employment desired:
Date available to start:
Have you ever been employed at Adkins before?: Yes No
Referred by:
If other, please specify:

Education

High School
Name, Location:
Major:
Graduated? Yes No
College
Name, Location:
Major:
Graduated? Yes No
Trade/Business School
Name, Location:
Major:
Graduated? Yes No
Do you have a current journeyman's license?
Yes No
Jouneymanship Number:
In what Counties are you licensed:
Do you have a fire alarm certification? Yes No
If so, when does it expire?

Capability / Reliability

Would you be willing and able to perform all of the tasks required by the job for which you are applying?: Yes No
If not, explain which tasks:
Do you have reliable transportation? Yes No
Will you abide by the safety rules of this company?: Yes No
How many days of work have you missed in the last two (2) years?:
How many times have you been late to work in the last two (2) years?:
Would you be wiiling and able to report to work on time every day on a regular and consistent basis?: Yes No
Are you able to lift up to 50lbs.: Yes No
Do you have any heavy equipment experience, i.e, backhoe, trencher, etc.:
Number of years:

Work Experience

List present and former employers beginning with the most recent.
From (mm/dd/yyyy): To (mm/dd/yyyy):
Employer: Phone Number:
Job title: Supervisor:
Duties (including project names): Salary:
Reason for leaving:
From (mm/dd/yyyy): To (mm/dd/yyyy):
Employer: Phone Number:
Job title: Supervisor:
Duties (including project names): Salary:
Reason for leaving:
From (mm/dd/yyyy): To (mm/dd/yyyy):
Employer: Phone Number:
Job title: Supervisor:
Duties (including project names): Salary:
Reason for leaving:
Have you worked for a temporary service in the past 12 months which provided us with labor?
Yes No
If so, Which agency / agencies

References

Name:
Business:
Phone:
Relationship:
Name:
Business:
Phone:
Relationship:
Name:
Business:
Phone:
Relationship:
 
The following statistical information is required for compliance with federal laws assuring equal employment opportunity. The information requested is voluntary.
Ethnicity:
Sex:
Male Female
Veteran Status:
Branch of Military:
   
I authorize investigation of all statements contained in this Application. I understand that misrepresentation or omission of facts called for in this Application and other relevant questionnaires is cause for dismissal. I understand and agree that my employment is "at will", and may be terminated by Adkins Electric, Inc. or myself at any time, for any reason, or no reason at all, with or without cause or notice, and is contigent on a 90 day probationary period. I understand it is my responsibility that I have transportation to work, and tardiness and absenteeism are grounds for dismissal.
NOTE: Leaving the job without notifying your job foreman, or failure to notify the office if you are going to be absent from work will be considered your voluntary termination of employment and your final paycheck will be issued as regularly scheduled.
Signature (type your name):
 

 
Florida EC-0000411
Georgia EN-003366
South Carolina M2739

Alabama 184
North Carolina 13972\00U
Texas 27141
     
Tennessee 63308
Louisiana 54306
Mississippi 18423-MC
     
Virginia 2705 135395A
Maryland 12535
Kentucky ME64283

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