Pre-Employment Application Applicant InformationApplicant Full Name* Home Address* City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address* Phone NumberJob Position Applied For: Job position applying for:Please SelectApprenticeJourneyman/MasterProject ManagerSalesOffice AssistantSalary Desired Who referred you to our company? Do you have any friends or relatives who work here? If yes, please list hereAre you at least 18 years old?Please SelectYesNoHow will you get to work? Are you willing to work any shift, including nights and weekends?Please SelectYesNoIf applicable, are you available to work overtime?Please SelectYesNoIf you are offered employment, when would you be available to begin work? If hired, are you able to submit proof that you are legally eligible for employment in the United States?Please SelectYesNoAre you able to perform the essential functions of the job position you seek with or without reasonable accommodation?Please SelectYesNoHave you ever been convicted of a felony or misdemeanor?Please SelectYesNoIf yes, please explain: THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.Applicant's Skills List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)Ability Skills Years of Experience RatingPlease Select12345Past Employers1Position Title Dates Employed Month Day Year Month Day Year Work PhoneStarting Pay Ending Pay Address Street Address City State / Province / Region ZIP / Postal Code 2Position Title Dates Employed Month Day Year Month Day Year Work PhoneStarting Pay Ending Pay Address Street Address City State / Province / Region ZIP / Postal Code 3Position Title Dates Employed Month Day Year Month Day Year Work PhoneStarting Pay Ending Pay Address Street Address City State / Province / Region ZIP / Postal Code Applicant's Education and Training College/University Name and AddressDid you receive a degree?Please SelectYesNoHigh School/GED Name and AddressDid you receive a degree?Please SelectYesNoOther Training (graduate, technical, vocational) Please indicate any current professional licenses or certifications that you hold Awards, Honors, Special Achievements Military ServicePlease SelectYesNoBranch Specialized Training References List any two non-relatives who would be willing to provide a reference for you.Name Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code TelephoneRelationship Name Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code TelephoneRelationship Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employerCERTIFICATION I certify that the information provided on this pre-application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize JW Shaw Electric to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of JW Shaw Electric, except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.Please attach resumes, cover letters, and supporting documents hereMax. file size: 100 MB.APPLICANT SIGNATUREMax. file size: 100 MB.Date MM slash DD slash YYYY Untitled Untitled
