Instructions to Applicant
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Milwaukee Only
INSTRUCTIONS TO APPLICANT:
1.COMPLETEALLINFORMATION requested. 2. PRINTanswers clearly. 3. SIGN and DATE application.
POSITION APPLIED FOR:Journeyman Inside Wireman
Apprentice Inside Wireman
Construction Wireman (CW)
Construction Electrician (CE)
S & C Technician
S & C Installer
Material Handler
Residential
Delivery Driver / Have you previously worked for Staff Electric Co.? Yes No
From To_Month / YearMonth / Year
From To_Month / YearMonth / Year
Reason for Leaving_
_
EMPLOYMENT INFORMATION
Are you legally authorized to work in the United States? Yes No
Are you at least 18 years old? Yes No
After work-related accidents or when the company has reasonable suspicion to believe an employee is using or abusing drugs, employees must take a drug and alcohol test. Can you comply with this policy? Yes No
Do you have the ability to get to work within a 75-mile radius? Yes No
Do you have the ability to perform all essential job functions with or without reasonable accommodationfor the position you are applying? Yes No
If not, please explain
Have you ever pled guilty to or been convicted of a felony or crime for any offense or violation other than minor traffic offenses? Yes No Please list all in space below.
(Note: A conviction does not automatically preclude you from employment.)
Do you have any pending criminal charges against you? Yes No
Please list all charges in space below.
(Note: A pending charge does not automatically preclude you from employment.)
ChargeDateLocationDisposition of Case
(Conviction/Pending/Dismissed)
EXPERIENCE
Are you a graduate apprentice? Yes No If not, when did you pass the journeyman’s
test atthe union? ______(Date)
Number of years experience in electrical construction trade ______
Have you ever been employed as a foreman? Yes No
CompanyProjectFromTo
WI License, Certifications, Registrations:
I.D. Number Expiration Date
Master Electrician______
Journeyman Electrician______
Electrical Apprentice______
Registered Electrician______
Other Category or State
______ ______
TRAINING
OSHA 10Yes NoCPR Yes No OSHA 30 Yes No
NFPA 70EYes NoScissors Lifts Yes No Fall Protection Yes No
First AidYes NoForkliftsYes No
Please list courses you have taken at JATC or other outside venues in last two (2) years:
SPECIALIZED SKILLS
Are you proficient in any of the following skills:
YN Project From To Comments
- Motor Controls
- Fire Alarm & Security
- Telecommunications
- Pipe Bending (larger than 2”)
- Medium Voltage (>600 v)
EMPLOYMENT HISTORY
List all present and past employment for the past three (3) years beginning with the most recent. Please use another page if necessary.
Company Name / Dates Worked
(From) (To) / Duties / Responsibilities
EMERGENCY CONTACT INFORMATION
(This information is voluntary and will be kept confidential)
Name / Relationship to Employee / Phone Number
Work / Home / Cell Phone
( ) / ( ) / ( )
( ) / ( ) / ( )
( ) / ( ) / ( )
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING YOUR NAME
I HEREBY CERTIFY that the answers provided by me to the above questions and statements are true and correct and hereby authorize Staff Electric Co. to contact references, past or present employers, persons, schools, law enforcement agencies, and any other sources of information, including a background check, which may be relevant to my application of employment. It is understood and agreed that any misrepresentation, false statement or omissions by me in this application will be sufficient reason for rejection of my application or for dismissal at any time during my employment without liability to Staff Electric Co. This includes furnishing a false name or social security number.
I have read, understand and agree to the above statement: ______(Please initial here)
I further understand that no representative of the Company has the authority to enter into any agreement for employment for any specified period of time and that this Company is not guaranteeing employment for anyone. No employment contract is created by virtue of my being hired by this Company, and, if hired, my employment will be at will and may be terminated at any time without prior notice.
I have read, understand and agree to the above statement: ______(Please initial here)
If employed, I agree to abide by all of the work and safety rules of Staff Electric. I understand that Staff Electric is committed to maintaining a drug-free workplace. I am aware that the Company may require a drug test as part of the hiring process for driving positions. Also, if employed, I realize that Staff Electric conducts post-accident and reasonable suspicion, drug and/or alcohol testing of its employees.
I have read, understand and agree to the above statement: ______(Please initial here)
I understand that this application will remain on file for 60 days for consideration. After 60 days, if I am still interested in a position with this company, it will be necessary for me to complete a new application form.
SIGN HERE ______DATE ______