Diversified Electrical Inc., Bowling Green, KY

Application For Employment

We are an equal opportunity employer. We comply with all applicable Federal, State, and Local laws concerning, discrimination in employment. No question in this application is intended to elicit information in violation of any such law nor will any information obtained in response to any question be used in violation of any such law.

Position applied for
Date of Application
Name (first,last,middle)
Address (Street,City,State,Zip)
Phone
Mobile, Beeper, Other Phone
Social Security Number
Have you ever been employed here before? Yes No
Are you legally eligible for employment in this country? Yes No
Date available for work
Type of employment desired: Full-Time Part-time Temporary Seasonal Educational

Salary Desired

Have you been convicted of a crime in the last (7) years? Yes No
If yes, please explain

Driver's license number if driving is an essential job function
State

Work Experience
(list present and former employers beginning with the most recent)

Most Recent Employer
Address (Street,City,State,Zip)
Immediate Supervisor and title
Summarize the nature of work performed and job responsibilities

Reason for leaving
Final hourly rate per hour

Previous Employer
Address (Street,City,State,Zip)
Supervisor and title
Summarize the nature of work performed and job responsibilities

Reason for leaving
Final hourly rate per hour

Skills and Qualifications
(Summarize any training, skills, licenses and/or certifications that may qualify you as being able to perform job-related functions in the position for which you are applying.)

Record of Education
(please state name and location of school,and year you graduated)

High School

College

Other

Personal References
(Not former employers or relatives, whom have known you at least one year)

1. Name
Address
Business
Years Known

2. Name
Address
Business
Years Known

3. Name
Address
Business
Years Known

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilizationof such information. I also understand and agree that no representatvie of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative."

I agree






	Application For Employment We are an equal opportunity employer. We comply with all applicable Federal, State, and Local laws concerning, discrimination in employment. No question in this application is intended to elicit information in violation of any such law nor will any information obtained in response to any question be used in violation of any such law. Position applied for Date of Application Name (first,last,middle) Address (Street,City,State,Zip) Phone Mobile, Beeper, Other Phone Social Security Number Have you ever been employed here before? Yes No Are you legally eligible for employment in this country? Yes No Date available for work Type of employment desired: Full-Time Part-time Temporary Seasonal Educational Salary Desired Have you been convicted of a crime in the last (7) years? Yes No If yes, please explain Driver's license number if driving is an essential job function State Work Experience (list present and former employers beginning with the most recent) Most Recent Employer Address (Street,City,State,Zip) Immediate Supervisor and title Summarize the nature of work performed and job responsibilities Reason for leaving Final hourly rate per hour Previous Employer Address (Street,City,State,Zip) Supervisor and title Summarize the nature of work performed and job responsibilities Reason for leaving Final hourly rate per hour Previous Employer Address (Street,City,State,Zip) Supervisor and title Summarize the nature of work performed and job responsibilities Reason for leaving Final hourly rate per hour Skills and Qualifications (Summarize any training, skills, licenses and/or certifications that may qualify you as being able to perform job-related functions in the position for which you are applying.) Record of Education (please state name and location of school,and year you graduated) High School College Other Personal References (Not former employers or relatives, whom have known you at least one year) 1. Name Address Business Years Known 2. Name Address Business Years Known 3. Name Address Business Years Known "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilizationof such information. I also understand and agree that no representatvie of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative." I agree