Employment

PERSONAL INFORMATION

Name:
Phone Number:
Email Address:
Current Address:
City:
Date of Birth:
Place of Birth:
Are you a US citizen?
Do you have a clean driving record?

EMPLOYMENT

Position Applying for:
Salary desired:
Are you currently employed?
May we contact?
Date available to start?

EDUCATION

Name and
Location
Years Attended Date Graduated Subject
High School:
         
Trade or Vocational:
         
College:

SPECIAL TRAINING/SKILLS OR MILITARY SERVICE:

EMPLOYMENT HISTORY

Start with your current employer going back 10 years:

Dates Employed Business Name
with Manager Name
& Phone #
Position Salary Reason For
Leaving
FROM / TO        

REFERENCES

List references, not related to you, who you’ve known at least two years.

Name Phone # Business Years Known
1.
2.
3.

PHYSICAL LIMITATIONS

Do you have any physical limitations to prevent you from performing any work for which you are applying (i.e. Standing, bending, crawling, climbing ladders, lifting)?

If yes, explain:

Have you ever been convicted of a crime?

If yes, explain:

Have you been previously employed by C.M.i.?

If yes, dates of employment:

I certify that answers provided by me (applicant) are true and complete to the best of my knowledge. I understand the information provided is subject to verification as a condition of employment. In event of employment, I understand that false or misleading information given in my application may result in discharge. I understand that I am required to abide by all rules and regulations set forth by C.M.i. A/C & Electrical. I also understand that C.M.i. A/C & Electrical is a drug free workplace and I must pass a pre-employment screening as a condition of employment.

Signature of Applicant: (type your full name)

Date:

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