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Job Application Form

Please fill out the entire form, answering all questions. An electronic signature will be required at the end. Forms are submitted to careers@rtelectricllc.com. A copy of your Drivers License and Social Security Card will be required if you are contacted in regards to a position. Thank you for your interest.

PERSONAL INFORMATION:

First Name: A value is required. Middle Name:

Last Name: A value is required. Nickname:

Social Security Number: A value is required. Date of Birth: A value is required.

Street Address: A value is required.

City, State, Zip: A value is required.

Phone Number: A value is required.	Cell Home Please make a selection.
Alternate Phone Number:	Cell Home

Emergency Contact Name: A value is required.

Relationship: A value is required. Phone Number: A value is required.

Are you eligible to work in the United States?	Yes No Please make a selection.
Have you been convicted of or pleaded no contest to a felony within the last five (5) years?	Yes No Please make a selection.

If yes, please explain:

Position Applying For: A value is required. Pay Requested ($ per hour) A value is required.

Work hours are Monday through Friday from 7:00 a.m. to 3:30 p.m. No overtime is allowed unless approved in advance by management.

What Date are you Eligible to Start Work? A value is required.

EDUCATION:

Name and Address of School:	Degree/Diploma:	Graduation Date:
Name and Address of School:	Degree/Diploma:	Graduation Date:
Name and Address of School:	Degree/Diploma:	Graduation Date:
Name and Address of School:	Degree/Diploma:	Graduation Date:

Skills and Qualifications: Licenses, Skills, Training, Awards:

EMPLOYMENT HISTORY:

Present or Most Recent Position: A value is required.

Employed By: A value is required.

Employer's Address:

Employer's Phone: Employer's Email

Position Title: Dates Worked (from - to)

Responsibilities:
Salary:

Reason for Leaving

Previous Position:

Previous Employer:

Previous Employer's Address:

Employer's Phone: Employer's Email

Position Title: Dates Worked (from - to)

Responsibilities:
Salary:

Reason for Leaving

May we contact your present/past employer?

Yes
No

References (Include First and Last Name, Title (if applicable), Address and Phone):

Reference One:
A value is required.

Reference Two:
A value is required.

Reference Three:
A value is required.

ELECTRONIC SIGNATURE

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

By typing your first and last names below, you are electronically signing this document.

Signature: A value is required. Date: A value is required.

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