| MIDDLETON ELECTRIC CO. PO BOX 447 GRAND ISLAND, NE 68802 (308)382-2550 |
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| APPLICATION FOR EMPLOYMENT |
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| P E R S O N A L |
Date________________ Telephone#:__________________ Drivers License #:__________________ Name___________________________________________ Soc Security #:____________________ Present Address____________________________________________________________________ Position Applying For________________________________________________________________ Are you legally eligible for employment in the United States?__________________________________ |
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| Have you, in the last 7 years, been convicted of a misdemeanor or felony? (A conviction will not necessarily bar you from employment. Each conviction will be judged on its own merit with respect to time, circumstances seriousness.) ______________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ |
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| If hired, how soon would you be able to start work?_____________________________________ Are you able to work overtime including Saturdays____________________________________ Are youavailable to travel to projects out of town_____________________________________ What is the minimum salary you would require to consider employment?_____________________ If you are hired you will be required to furnish your own hand tools. Do you presently own tools of your trade?_______________ Do you own transportation?_________________ Are you over 18 years of age?_______________ How much experience do you have for the position you are seeking_______________________ Have you worked for this company before, if so, when __________________________________ Do you haveany medical problems we should be aware of, or that would affect your ability to perform your trade? If so, please explain________________________________________________________ ______________________________________________________________________________ |
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| Experience: (Work related references are preferred. Personal
references are secondary) NAME COMPANY NAME, ADDRESS, ZIP CODE PHONE ____________________ ____________________________________________ ____________________ ____________________ ____________________________________________ ____________________ ____________________ ____________________________________________ ____________________ |
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| EDUCATION
LEVEL ATTAINED
FIELD OF STUDY __________________________ ________________________________ __________________________ __________________________ ________________________________ __________________________ __________________________ ________________________________ __________________________ |
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| Please supply any further information which would help us
evaluate your qualifications the job you are seeking: |
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| In case of emergency who should we notify? Name:________________________________ Relationship:___________________________________ Address: ___________________________________________________________________________ Phone:________________________________ |
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| ACKNOWLEDGMENT: I understand and acknowledge that false statements of this application may be considered sufficient cause for dismissal if and when discovered. I further understand that acceptance of my application by the Company does not indicate there are currently positions open nor does it in any way guarantee that I will be offered a job. I also understand that if I am offered and accept a job, the Company reserves and retains the right to make such changes in the terms and conditions of my employment as the Company determines to be necessary or appropriate. In consideration of my potential employment, I agree to conform to the rules of the Company and agree that my future employment and compensation can be terminated, with or without cause, at any time, at the option of either the Company or myself. I understand that no representative of the Company other than the Owner / President authority to enter any agreement regarding employment contrary to this acknowledgment and that any such agreement by the Owner / President shall be in writing. Date:______________________________ Signature:_______________________________ |
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