Employment Application If you are human, leave this field blank. EMPLOYMENT APPLICATION Position(s) Applying For: Application Date: Personal Information Name: * First Last: * Last Address: * Address: Address: Address: City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Home Phone: Cell Phone: Social Security Number: Email Address: Employment Information Citizenship/Work Status: U.S. Citizen Green Card Holder U.S. Work Permit/Visa Current Employer: (if any) Years of Work Experience: Directly Related to the position you are applying for. Employment Type Desired Full-Time Part-Time Desired Compensation Compensation Hourly Annual When are you available to start work? Education Type of School: High School College/University Bus. or Trade School Professional School Other Type of School: Name of School: Location of School: # of Years Completed Major & Degree Add RemoveCriminal History HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR? * No Yes(except any minor traffic violations) If yes, please explain and attach any relevant documentation. Drivers License Information DO YOU HAVE A VALID DRIVER'S LICENSE? * Yes No Do you have reliable transportation to work (please be specific)? * Driver's License Number: * State of Issue: * Military Service HAVE YOU EVER BEEN IN THE ARMED FORCES? Yes No Branch: ARE YOU CURRENTLY A MEMBER OF THE NATIONAL GUARD or RESERVES? Yes No Specialty: Date Entered: Discharge Date: Work ExperiencePlease list your work experience for the past 5 years beginning with your most recent job. If you were self-employed, give firm name. Attach additional sheets if necessary. Name of Employer: Name of Supervisor: Phone Number: Your Last Job Title: Employment Dates: From - To Pay or Salary Start - Final Address: Address: Address: Address: City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Specific Reason For Leaving: List the jobs you held, duties performed, skills learned, advancements or promotions while you worked at this company: May we contact this employer? Yes No Add RemoveElectrical Skills What type of systems have you worked with? (Select all that apply) Building Management Data Elevators Fire Systems High Voltage Hydraulic Systems Low Voltage Manufacturing Equipment Mechanical Systems Radio-RF Security Systems Signaling Systems Street & Highway Lighting Traffic Signaling Voice/Telecom What types of wiring have you worked with? (Select all that apply) 110 220 4160 480 Cat5 Coax Fiber Optic Phone What specific parts, accessories, or fixtures have you worked with? (Select all that apply) 3-Way Switches AC Attic Fans Ceiling Fans Circuit Breaker Box Conduit Pipe Conduit Tubing Control Panel DC Dimmer Switches Electric Meter Electrical Switchgear Assemblies Fluorescent Lighting Fuse Box Fuses Generators Halogen Lighting Intercoms Lighting Fixtures - Recessed Lighting Fixtures - Surface Mount Load Centers Motor Controls Motors Outlets Panel Boards PLC Relays Service Box Terminals Transformers Variable Frequency Drive Wall SwitchCertifications & Licenses What Certifications & Licenses do you have? (Select all that apply) Apprentice Electrician License Journeyman Electrician License Master Electrician License Include State and License Numbers for any licenses selected above, if applicable: Other Licenses & Certifications held: Professional References Name: First Last: Last Position: Company: Phone Number: Email Address: Add Remove Attach Resume or Any Relevant Documentation: Uploading Files. Please Wait. Drop a file here or click to upload Choose File Maximum upload size: 134.22MB AGREEMENT (PLEASE READ CAREFULLY BEFORE SIGNING)I certify that all the information on this application is accurate and complete to the best of my knowledge and understand that misleading or false statements will constitute sufficient cause for refusal of hire or termination of my employment.I understand that neither the acceptance of this application nor the subsequent entry into any type of employment relationship with O'Neil Electric creates an actual or implied contract of employment. I understand that if I accept employment with O'Neil Electric, it will be on an at-will basis. This means that either O'Neil Electric or I have the right to terminate the employment relationship at any time, for any reason, with or without cause.I agree to submit to drug and alcohol testing, if requested by O'Neil Electric. I release O'Neil Electric, and its employees, plus other persons or companies, from any and all liability arising out of or related in any way to such testing.I authorize O'Neil Electric to investigate information concerning my education, licensing, certifications, driving record, criminal history, employment experiences, and all other aspects of my background relevant to my proposed employment. I release O'Neil Electric and its employees from all liability arising from such investigation. Signature of Applicant: Date: O'Neil Electric is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age, or disability. We assure you that your opportunity for employment with O'Neil Electric depends solely on your qualifications. Submit