• First name:
• Last name:

• SS#:
• Email:

• Present Address:


• City:

• Permanent Address:


• City:

• Phone Number:
• Referred By:

• Are you currently attending school?
• Yes
• No

• Position Desired:
• Date you can begin work:

• Do you have reliable transportation every day?
• Yes
• No

• Wage Desired:
• Is your Electrical License current?:
• Yes
• No

• What level of electrical license have you obtained?

• List any additional industry certifications or licenses you hold:

• Are you currently Employed?
• Yes
• no
• May we contact them?
• Yes
• no

• Have you ever applied to this company before?
• Yes
• no
• When?

• School
• Name of School & Location
• Subjects or Degree
• Date Graduated

• High School:

• College:

• Special Study:

• Subjects of special study or research work:

• Special Training:

• Activities (Civic, Athletic, ect.)

Please list below your last three employers, starting with present or most recent.

• Employer:
• Employed from:
• to:

• Company Address:


• phone:

• Position/Duties:


• Wage:
• Supervisor:

• Reason for leaving:

• Employer:
• Employed from:
• to:

• Company Address:


• phone:

• Position/Duties:


• Wage:
• Supervisor:

• Reason for leaving:

• Employer:
• Employed from:
• to:

• Company Address:


• phone:

• Position/Duties:


• Wage:
• Supervisor:

• Reason for leaving:

• Name
• Phone
• Business
• Years Acquainted

• Contact 1:

• Contact 2:

• Contact 3:

**Please note that Tri-Phase Electric has and abides by a Zero Tolerance drug Policy. Pre-Employment drug tests are given along with random drug tests throughout employment.-+++