Employment Application

Name

Phone

Address

Are you a licensed Electrician?

Type of License?

License Number

Is your license current?

Are you currently attending the IEC Program?

If yes, current year in school?

Previously employed by an IEC member?

Are you over the age 18?

Do you have a Driver's License?

Are you a U.S Citizen?

Have you ever been convicted of, or pleaded guilty, to a criminal violation?

If yes, Please explain:

Education:

Highest Level of Education:

Name of School:

Years attended:

Have you attended an Electrical Apprenticeship School?

If yes, years attended:

If yes, What School?

Did you complete

Draft & Military:

Are you a Veteran?

Branch of Service?

Service Dates

List, Highest Rank & duties in the service, inlcuding special training?

Employment Desired:

Identify the position for which you are applying:

Years of experience

Identify any benefits or other terms of employment you are seeking:

Are you able to perform all of the duties required for the job you are applying for?

Rate of pay you are seeking:

Employment History:

Most Recent Job:

Company Name:

Company Address:

Supervisor's Name:

Phone Number:

Salary:

Position:

Reason For Leaving:

Date hired to departure:

Job Duties:

Second Most Recent Job:

Company Name:

Company Address:

Supervisor's Name:

Phone Number:

Salary:

Position:

Reason For Leaving:

Date hired to departure:

Job Duties:

Third Most Recent Job:

Company Name:

Company Address:

Supervisor's Name:

Phone Number:

Salary:

Position:

Reason For Leaving:

Date hired to departure:

Job Duties:

References:

First Reference

Name:

Company:

Phone:

Years acquainted:

Second Reference

Name:

Company:

Phone:

Years acquainted:

I acknowledge that I have been told that IEC is merely a conduit through which applications are made available to IEC Members and that the IEC and its members do not guarantee or promise that I will be offered employment, or even considered for employment by one or more IEC members, or that my application will be forwarded to a specific IEC member. Rather, I have been told that the IEC makes available to its members the active applications on file with the IEC, upon request by the member. I also understand that if an IEC member wishes to consider me for employment, I will be required to appear at the member’s facility and be interviewed in person before I will be considered for employment by the member. I also understand that after my interview, the individual IEC member who interviews me may obtain applications from other sources, such as former employees, word of mouth or advertising, and that individual IEC member may have additional employment criteria, experience requirements, testing (including drug test) or other conditions for employment that may determine whether I have qualifications for employment and whether I will be chosen from among other qualified applicants.

I understand that my failure to answer any question or provide any information requested on this application form will render my application void and I will not be considered for employment. I further acknowledge that I have been told that my application will be considered active for only 15 days, and I must return after the 15-day period to complete another application to be further considered.

IN ADDITION, I UNDERSTAND THAT ANY FALSIFICATION, MISREPRESENTATION AND/OR WITHHOLDING OF INFORMATION ON THIS APPLICATION WILL BAR ME FROM THE USE OF THIS SERVICE IN THE FUTURE AND SUBJECT ME TO A CIVIL LAWSUIT.

I certify that the above statements are true and correct and understand that any misrepresentation on this application is cause for not being hired, as well as being dismissed, without regard to when my employer discovers the misrepresentation.

I hereby authorize the IEC, its members, and their representatives, to investigate my background and medical history on the terms set forth in this authorization form.

I apply for this job and, if offered same, will accept employment, understanding that my employer’s policy is to provide “at will” employment, which means that either I or my employer can terminate my employment at any time, with or without cause. I understand that no employee, officer, or representative of my employer has the authority to agree to employment terms other than “at will” employment, with the exception

Signature: