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MIDDLETON ELECTRIC CO. PO BOX 447 GRAND ISLAND, NE 68802 (308)382-2550 APPLICATION
FOR EMPLOYMENT P E
Date:_________________Telephone
#:__________________Drivers License #:__________________ R
Name:____________________________________________Soc
Security #:____________________ S
Present Address:_____________________________________________________________________ O
Position Applying For:_________________________________________________________________ N
Are you legally eligible for employment in the United States?___________________________________ A L ________________________ ________________________ _____________________ Present &
Previous Employer Present & Previous Employer Present & Previous
Employer ________________________ ________________________ _____________________
Position Position Position ________________________ ________________________ _____________________ Dates Employed Dates Employed Dates
Employed ________________________ ________________________ _____________________ Wage Wage Wage ________________________ ________________________ _____________________ Reason For Leaving Reason For Leaving Reason
For Leaving Have you, in
the last 7 years, been convicted of a misdemeanor or felony? (A conviction will not necessarily bar you
from employment. Each conviction will be
judged on its own merit with respect to time, circumstances & seriousness.)
____________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ If hired,
how soon would you be able to start work?_____________________________________ Are you able
to work overtime including Saturdays?_____________________________________ Are you
available to travel to projects out of town?______________________________________ What is the
minimum salary you would require to consider employment?_____________________ If you are
hired you will be required to furnish your own hand tools. Do you presently own tools of your trade?_______________ Do you own transportation?_________________Are
you over 18 years of age?_______________ How much
experience do you have for the position you are seeking?________________________ Have you
worked for this company before, if so, when?___________________________________ Do you have
any medical problems we should be aware of, or that would affect your ability
to perform your trade? If so, please
explain________________________________________________________ ______________________________________________________________________________ Experience: (Work related references are preferred. Personal references are secondary) NAME COMPANY NAME, ADDRESS, ZIP CODE PHONE ____________________ ________________________________________________________________ ____________________ ________________________________________________________________ ____________________ ________________________________________________________________ EDUCATION
LEVEL ATTAINED FIELD OF STUDY ________________________ ________________________________________________________ ________________________ ________________________________________________________ ________________________ ________________________________________________________ ________________________ ________________________________________________________
Please supply
any further information which would help us evaluate your qualifications
for the job you are seeking: In case of
emergency who should we notify? Name:_________________________________
Relationship:___________________________________ Address:_______________________________________________________________________________ Phone:_________________________________ ACKNOWLEDGMENT: I understand
and acknowledge that false statements of this application may be considered
sufficient cause for dismissal if and when discovered. I further understand that acceptance of my
application by the Company does not indicate there are currently positions open
nor does it in any way guarantee that I will be offered a job. I also understand that if I am offered and
accept a job, the Company reserves and retains the right
to make such changes in the terms and conditions of my employment as the
Company determines to be necessary or appropriate. In
consideration of my potential employment, I agree to conform to the rules of
the Company and agree that my future employment and compensation can be
terminated, with or without cause, at any time, at the option of either the
Company or myself. I understand that no
representative of the Company other than the Owner /
President has authority to enter any agreement
regarding employment contrary to this acknowledgment and that any such
agreement by the Owner / President shall be in writing. Date:_______________________________ Signature:_______________________________ |