| Employment Application |
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DATE: |
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| SUMMARY
APPLICATION |
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Summary:
CONTACT INFO |
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Name |
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First |
Middle |
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Last |
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Contact Numbers |
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Home |
Cell |
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Social Security # |
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US Citizen ? |
[ ]-YES |
[ ]-NO |
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Summary: EMPLOYMENT INFO |
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Position Applied For: |
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[
]-J-man [ ]-Mechanic [ ]-Helper |
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Electrical Skill Level |
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Salary Desired: |
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/hour |
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Are you currently employed full time?
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[ ]-YES |
[ ]-NO |
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Current Employer |
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YrsWith |
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Company Name |
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City |
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Summary:
BACKGROUND ELIGIBILITY |
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Do you have a valid driver license?
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[ ]-YES |
[ ]-NO |
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DL# |
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[ ]-Safe Driver [ ]-Operator [
]-CDL Class ____ |
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License Type |
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Has your license been suspended in the last 5
years?
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[ ]-YES |
[ ]-NO |
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Have you had an auto accidents (regardless of
fault) in last 3 years?
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[ ]-YES |
[ ]-NO |
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Have you had more than 2 moving violations in
the last 2 years?
...
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[ ]-YES |
[ ]-NO |
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Are you certain that the above statements are
correct?
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[ ]-YES |
[ ]-NO |
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Summary:
STATEMENT OF INTENT |
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Describe what are your most important factors
in a job (salary, benefits, stability, overtime, environment, etc.)? |
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and/or Describe your
3-5 year goals and/or Describe your things that are important in your personal
life. |
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Enterprise Fleet |
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ADMINISTRATIVE SOLUTIONS, INC. |
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Vehicle Provider for Wesworth |
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Employee Leasing Provider for Wesworth |
| DETAILED
APPLICATION |
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PERSONAL INFORMATION |
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Current Address |
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Street |
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City |
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Zip |
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EMPLOYMENT HISTORY |
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O N E |
Employr |
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FROM |
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City |
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Reason for Leaving |
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Postion |
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Wage |
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----------------------------------------------------------------------------------------------------------------------------------------------------------- |
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T W O |
Employr |
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FROM |
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City |
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Reason for Leaving |
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Postion |
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Wage |
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----------------------------------------------------------------------------------------------------------------------------------------------------------- |
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T H R E E |
Employr |
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FROM |
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City |
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Reason for Leaving |
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Postion |
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Wage |
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EDUCATION/QUALIFICATIONS |
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Have you obtained a High School Degree or
Equivalent? |
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[ ]-YES |
[ ]-NO |
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Have you obtained a College Degree? |
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[ ]-YES
(2yr) [ ]-YES (4yr) |
[ ]-NO |
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Please descrive any other education, including
trade schools |
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Please list any electrical licenses, current or
expired |
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Type |
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Locale/Jurisdiction |
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Status |
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Please list any trade certifactions or
qualification that may be relevant |
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Type |
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Locale/Jurisdiction |
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Status |
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TECHNICAL KNOWLEDGE |
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On a scale from 1 to 10 (1= novice, 10 =
expert) please describe your experience level |
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Resid New
Construction |
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Resid Remodeling |
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Resid Service |
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Commercial Service |
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Commercial New Constrctn |
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Retrofitting |
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Industrial Service (480v) |
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Computers, Data Technologies |
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Motor Control |
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Fire Alarm, Nurse Call |
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BACKGROUND/ELIGABILITY |
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Have you ever been in the
Military?
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[ ]-YES |
[ ]-NO |
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If Yes, Describe details |
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Have you ever been convicted of a
Felony?
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[ ]-YES |
[ ]-NO |
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If Yes, Describe details |
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Have you ever been charged with
DUI?
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[ ]-YES |
[ ]-NO |
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If Yes, Describe details |
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Did you have serious driving record events (if answered Yes on pg1)?
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[ ]-YES |
[ ]-NO |
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If Yes, Describe details |
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AVAILABILITY |
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How soon can you start? |
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Would you be willing to work during weekends? |
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[
]-Frequently [ ]-Occasionally |
[
]-Never/Rarely |
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Would you be willing to work during evenings? |
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[
]-Frequently [ ]-Occasionally |
[
]-Never/Rarely |
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REFERENCES/ADDITIONAL COMMENTS |
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Feel free to provide references with phone
numbers and/or provide
additional info for us to consider. |
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>>>YOUR APPLICATION IS NOT YET
COMPLETE
TURN TO PAGE FOUR>>>> |
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WESWORTH SUPERVISOR COMMENTS |
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APPLICATION FORM WAIVER |
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Please read carefully, the preceeding
information you provided may be verified through various |
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agencies, affilates or service providers of
Wesworth. This waiver grants us
rights to make these |
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investigations. All employees must be verfified, so signature of this waiver is
required for employment |
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consideration. |
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In exchange for
the consideration of my job application by WESWORTH ELECTRIC, INC.
(hereinafter called the Company), I agree that: |
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Neither the
acceptance of this application nor the subsequent entry into any type of
employment relationship, either in the position applied for or any other
position, and regardless of the contents of employee handbooks, personnel
manuals, benefit plans, policy statements, and the like as they may exist
from time to time, or other Company practices, shall serve to create an
actual or implied contract of employment, or to confer any right to remain an
employee of WESWORTH, or
otherwise to change in any respect the employment-at-will relationship
between it and the undersigned, and that relationship cannot be altered
except by a written instrument signed by the President /General Manager of
the Company. Both the undersigned and
WESWORTH may end the employment relationship at any
time, without specified notice or reason.
If employed, I understand that the Company may unilaterally change or
revise their benefits, policies and procedures and such changes may include
reduction in benefits. |
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I authorize
investigation of all statements contained in this application. I understand that the misrepresentation or
omission of facts called for is cause for dismissal at any time without any
previous notice. I hereby give the
Company permission to contact schools, previous employers (unless otherwise
indicated), references, and others, and hereby release the Company from any
liability as a result of such contract. |
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I also understand
that (1) the Company has a drug and alcohol policy that provides for
pre-employment testing as well as testing after employment; (2) consent to
and compliance with such policy is a condition of my employment; and (3)
continued employment is based on the successful passing of testing under such
policy. I further understand that
continued employment may be based on the successful passing of job-related
physical examinations. |
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I understand
that, in connection with the routine processing of your employment
application, the Company may request from a consumer reporting agency an
investigative consumer report including information as to my credit records,
character, general reputation, personal characteristics, and mode of
living. Upon written request from me,
the Company, will provide me with additional information concerning the
nature and scope of any such report requested by it, as required by the Fair
Credit Reporting Act. |
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I understand
that, in connection with the processing of your application, the Company will
request drivers information. This
information may be shared with companys insurance, leasing agencies, or
other vehicular vendors. Due to the
nature of this business, the driving record will be a significant factor in
your employment. Failure to fully and
properly disclose the nature of your record is grounds for termination. |
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I further
understand that my employment with the Company shall be probationary for a
period of sixty (60) days, and further that at any time during the
probationary period or thereafter, my employment relation with the Company is
terminable at will for any reason by either party. |
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Signature of Applicant |
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Date |
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This Company is
an equal employment opportunity employer.
We adhere to a policy of making employment decisions without regard to
race, color, religion, sex, sexual orientation, national origin, citizenship,
age or disability. We assure you that
your opportunity for employment with this Company depends solely on your
qualifications. |
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