Job Application | Speelman Electric

Personal Information

Availability

Position Applying For*

Available Start Date

Currently Employed?

Yes

Name

First Name*

Last Name*

Middle Name

Contact

Home Phone No

Cell No*

Email*

Address

Street

Apt.#

City / State*

Zip Code*

Emergency Contact

In case of emergency, please list contact and phone number.

Emergency Contact Name

Emergency Contact Number

Emergency Contact Relationship

Referral / Relation

If related to anyone in our company, state name and function.

Name

Function

Referred By

Former Employers

(List below your last three employers, starting with the most recent)

Employer 1

Employer Name and Address

Supervisor’s Name and Phone Number

Position Title

Reason for Leaving

Joining Date (month and year)

Leaving Date (month and year)

Employer 2

Employer Name and Address

Supervisor’s Name and Phone Number

Position Title

Reason for Leaving

Joining Date (month and year)

Leaving Date (month and year)

Employer 3

Employer Name and Address

Supervisor’s Name and Phone Number

Position Title

Reason for Leaving

Joining Date (month and year)

Leaving Date (month and year)

References

(List below the names of three persons, not related to you, whom you have known for at least two years)

Reference 1

Reference #1 Name

Address/Phone Number

Reference #1 Relationship

Reference #1 Years Acquainted

Reference 2

Reference #2 Name

Address/Phone Number

Reference #2 Relationship

Reference #2 Years Acquainted

Reference 3

Reference #3 Name

Address/Phone Number

Reference #3 Relationship

Reference #3 Years Acquainted

Respond to the following questions:

Are you eligible to work in the U.S.?*

Yes

Do you have a valid driver’s license?*

Yes

Do you have a CDL?*

Yes

We are a 100% drug-free workplace. Will this create a challenge for you?*

Yes

Speelman Electric, Inc. is a drug-free environment. All applicants will be drug tested. Any false statements made on this application will be grounds for termination. Speelman Electric, Inc. is an Equal Opportunity Employer.

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