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Thank you for your interest in our company! Acme Electric is an equal opportunity employer and does not
discriminate against applicants or employees on the basis of sex, race, color, creed, religion, ancestry, national
origin, sexual orientation, marital status, status with regard to public assistance, or military experience.

Name: Date:
Last First M.I.

Address:
Number Street City State Zip

Telephone:
Position(s) you are interested in: FT or PT
Have you been employed here previously? Are you over 18 years old?
List friends or relatives that work for us:
When are you available to start?

EDUCATION:
High School Attended: Did you graduate?
College(s) Attended: Did you graduate?
Major: Do you intend to return to school? If so, when?

PAST EMPLOYERS: List former employers, starting with your current or most recent employer.

Name of company:
Address: Phone:
Beginning date of employment: Ending:
Describe the work you did:

Starting salary: Ending salary: Supervisor:

Reason for leaving:

Name of company:
Address: Phone:
Beginning date of employment: Ending:
Describe the work you did:

Starting salary: Ending salary: Supervisor:

Reason for leaving:
PAST EMPLOYERS
Name of company:
Address: Phone:
Beginning date of employment: Ending:
Describe the work you did:

Starting salary: Ending salary: Supervisor:

Reason for leaving:

Name of company:
Address: Phone:
Beginning date of employment: Ending:
Describe the work you did:

Starting salary: Ending salary: Supervisor:

Reason for leaving:
May we contact your current employer? Yes: No: N.A.

REFERENCES: No relatives
Name Occupation Address Phone#

SKILLS: List any special skills, experiences, training, or qualifications.

Valid drivers license? Endorsements: License#

I certify that all facts contained in this application are true and complete and acknowledge that Acme
Electric is relying on the accuracy of the information provided. I authorize Acme Electric to verify the accuracy
of the information provided herein, and I authorize former employers and references to provide information
about me in response to inquiries by Acme Electric. I understand that falsification, misrepresentation, or omission
of requested facts may result in denial of employment or, if employed, may result in immediate dismissal.
I understand and agree that, if hired, my employment will be for no definite period and may, regardless of the
date of payment of wages, be terminated at any time without previous notice and with or without reason,
at the will of either myself or Acme Electric.

Signature: Date:

If hired, proof of your identity and employment eligibility in the United States must be established by
appropriate documentation at the time you begin work.