Design Electric

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Employment Application Page

We are a class A contractor in Charlottesville, Virginia doing work in the mid-Atlantic states.

We appreciate your interest in our company. We also invite you to fill out one of our employment applications below and submit it for our review.

We are currently hiring for the following positions:

Master Electrician

Journeyman Electrician

Electrical Apprentice

APPLICATION FOR EMPLOYMENT

All statements made by applicants for employment on this form will be carefully checked for accuracy. We offer equal employment opportunities for all persons without regard to race, religion, sex, national origin, or handicap. The use of this form does not mean there are positions open and does not obligate us in any way.

PERSONAL INFORMATION:

Date Phone Number:
E-Mail Address:

Have you ever worked for Design Electric, Inc. before?

Name (First, Middle, Last)

Street Address

City State Zip Code

Social Security No.: Valid Driver's License?

J-man/Master's Card?

Are you over the age of 18?

(If NO, employment is subject to verification of age)

Date of Birth (mm/dd/yyyy)

Position applied for:
Rate of pay expected:

How soon could you report to work?

Type of employment you are seeking

Type of School	Name and Location of School	Major Courses	Choose Last Year Completed	Graduate? (Give Degrees below)
Elementary		N/A		N/A
High School
College
Other
If you received any Degrees, please list here:

REFERENCES: (Do not list relatives or former employers)
Name:		Address:
Telephone:		Occupation:
Name:		Address:
Telephone:		Occupation:
Name:		Address:
Telephone:		Occupation:

PLEASE READ THE FOLLOWING VOLUNTARY CONSENT FOR BACKGROUND REPORT:

In order to permit Design Electric to verify information provided in connection with my employment I hereby consent to the procurement of a background report. This report may contain information regarding my previous employment, credit history, drug use, and/or criminal convictions, or any other items stipulated on my resume or employment application.

I understand that any information obtained will be held in strict confidence and that I will be entitled to a copy upon written request. I also understand and agree that if the report reveals that false or misleading information was used to obtain a job, it will be grounds for dismissal.

Do you accept? (Please type YES or NO)

EMPLOYMENT HISTORY:

Starting with your most recent (or present) job position, please enter the following information to indicate your PRIOR WORK RECORD.

Employer Name: Address:

Telephone No: Supervisor:

Your job title and duties:

Date hired: Date left:
Starting Rate: Last Rate:

Reasons for leaving:

Employer Name: Address:

Telephone No: Supervisor:

Your job title and duties:

Date hired: Date left:
Starting Rate: Last Rate:

Reasons for leaving:

Employer Name: Address:

Telephone No: Supervisor:

Your job title and duties:

Date hired: Date left:
Starting Rate: Last Rate:

Reasons for leaving:

PLEASE ANSWER THE FOLLOWING QUESTIONS:

Have you ever been discharged or requested to resign from a position?

If so, please explain:

How much time have you lost from work during this past year?

Why?