Employment Application Name: Position applied for: E-mail Address: Address: Contact Phone #: Birth date: Do you Have Valid Social Security # Yes No If you are under 18 years of age, can you provide required proof of your eligibility to work? YesNoNot applicable Have you ever applied with us before? If yes, please provide date. YesNo Date of previous application: Do any of your friends or relatives, other then a spouse, who work here? If yes, state name, relationship and location. Are you currently employed? If so may we contact your current employer? Yes- ok to contact Yes- do not contact No- currently not employed Are you legally eligible for employment in the united states? YesNo Date available to start working. Are you able to work: Full Time Part Time Temporary If you selected part time or temporary please indicate availability: Are you afraid of heights? Yes No Do you have any Medical Conditions which may affect your ability to perform the job duties? Yes No if yes, Explain medical limitations Have you ever been convicted of a crime? Yes No If yes, Explain Conviction. Can you travel if a job requires it? Yes No Education- please check all that apply High school diploma G.E.D. Undergraduate College Graduate/Professional Trade school Other Please provide info for each education box checked Work experience-1: May we contact-1? Yes No Work experience-2: May we contact-2? Yes No Work experience-3: May we contact-3? Yes No Work experience-4: May we contact-4? Yes No Comments: please explain any gaps in employment Describe any specialized training, skills and extra curricular activities List Professional, trade, business or civic activities and offices held. Are you or were you ever a member of a union? (if Yes , has the membership been terminated? When?) Yes No Yes- Membership Terminated Union membership termination date. Specialized Skills Computer Literate Bi-lingual Machinery Operation Networking Programing Other Additional Information. (Summarize any additional skills or qualifications) Positions at Holm Electric may require working on extension ladders, working in confide spaces lifting an excess of Personal Refferances Send
