Pre-Employment Application
| Name: |
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| Social Security Number: |
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| Address: |
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| City, State, Zip Code: |
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| Phone Number: |
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| Mobile, Beeper, Other: |
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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.
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| Are you able to meet the attendance requirements for the position? |
Yes
No |
| Are you willing to travel? |
Yes
No |
| Drivers License: State & Number: |
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| License Type: |
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| Currently Valid? |
Yes
No |
Employment Desired |
| Position(s) applied for: |
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| Desired Salary: |
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| Type of employment desired: |
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| Date available to start: |
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| Have you ever been employed at Adkins before?: |
Yes
No |
Referred by: |
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If other, please specify: |
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Education
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High School |
Name, Location: |
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| Major: |
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| Graduated? |
Yes
No |
| College |
| Name, Location: |
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| Major: |
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| Graduated? |
Yes
No |
| Trade/Business School |
| Name, Location: |
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| Major: |
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| Graduated? |
Yes
No |
Do you have a current journeyman's license? |
Yes
No |
| Jouneymanship Number: |
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| In what Counties are you licensed: |
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| Do you have a fire alarm certification? |
Yes
No |
| If so, when does it expire? |
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| US Military or Naval Service: |
Yes
No |
| If yes, what rank?: |
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Are you a member in the National Guard or Reserves: |
Yes
No |
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: |
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| 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?: |
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How many times have you been late to work in the last two (2) years?: |
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| 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.: |
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Number of years: |
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Work Experience |
| List present and former employers beginning with the most recent. |
| From (mm/dd/yyyy):
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To (mm/dd/yyyy):
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| Employer:
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Phone Number:
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| Job title:
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Supervisor:
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| Duties (including project names):
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Salary:
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| Reason for leaving:
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| From (mm/dd/yyyy):
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To (mm/dd/yyyy):
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| Employer:
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Phone Number:
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| Job title:
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Supervisor:
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| Duties (including project names):
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Salary:
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| Reason for leaving:
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| From (mm/dd/yyyy):
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To (mm/dd/yyyy):
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| Employer:
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Phone Number:
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| Job title:
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Supervisor:
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| Duties (including project names):
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Salary:
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| Reason for leaving:
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Have you worked for a temporary service in the past 12 months which provided us with labor? |
Yes
No |
| If so, Which agency / agencies |
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References
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| Name: |
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| Business: |
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| Phone: |
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| Relationship: |
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| Name: |
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| Business: |
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| Phone: |
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| Relationship: |
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| Name: |
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| Business: |
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| Phone: |
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| Relationship: |
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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.
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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.
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| Signature (type your name): |
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