Employment Application

1. Employer Information

Employer: Helping Hands Electric
Address: 6725 Seybold Rd, STE B
City/State/ZIP: Madison, Wisconsin 53719
Telephone: (608) 424-4301

It is the policy of Helping Hands Electric to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

2. Applicant Information

Applicant Full Name

Home Address

City/State/ZIP

Number of years at this address

Daytime phone

Evening phone

Mobile Phone

Job Position Applied For: Journeyman Electrician

Salary Desired

$ per

Who referred you to our company?

Do you have any friends or relatives who work here? If yes, please list here

Are you at least 18 years old?

How will you get to work?

Are you willing to work any shift, including nights and weekends?

If applicable, are you available to work overtime?

If you are offered employment, when would you be available to begin work?

If hired, are you able to submit proof that you are legally eligible for employment in the United States?

Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?

Have you ever been convicted of a felony or misdemeanor?

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

Applicant's Skills

List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

Ability Skills	Years of Experience	Rating

Applicant Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.

Employer Name:
Supervisor Name:
Address:
City/State/ZIP:
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):

Applicant's Education and Training

College/University Name and Address

Did you receive a degree?

High School/GED Name and Address

Did you receive a degree?

Other Training (graduate, technical, vocational)

Please indicate any current professional licenses or certifications that you hold

Awards, Honors, Special Achievements

Military Service

Branch

Specialized Training

References

List any two non-relatives who would be willing to provide a reference for you.

Name

Address

City/State/ZIP

Telephone

Relationship

Name

Address

City/State/ZIP

Telephone

Relationship

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer

CERTIFICATION

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Helping Hands Electric to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Helping Hands Electric, except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

APPLICANT SIGNATURE

DATE

Verification Code