Employment

General information

Name

First

Last

Address

Street Address

Address Line 2

City

State

Zipcode

Email

Phone

Resume

Are you 18 years of age or older?

Yes
No

What is your expected salary?

Annual
Hour

Employment History

1. Current or most recent employer

If so, may we contact them? Yes No

Employer

Telephone

City

State (*if in US)

Country:

Job Title

Supervisor

Department

Final Salary

Dates Employed
to

Duties/Reponsibilities:

If less than full time, please explain:

Reason for leaving:

2. Current or most recent employer

If so, may we contact them? Yes No

Employer

Telephone

City

State (*if in US)

Country:

Job Title

Supervisor

Department

Final Salary

Dates Employed
to

Duties/Reponsibilities:

If less than full time, please explain:

Reason for leaving:

3. Current or most recent employer

If so, may we contact them? Yes No

Employer

Telephone

City

State (*if in US)

Country:

Job Title

Supervisor

Department

Final Salary

Dates Employed
to

Duties/Reponsibilities:

If less than full time, please explain:

Reason for leaving:

Education Information

No formal education

High School

Institution Name

City

State (*if in US)

Country:

Did you graduate?

Yes No

Grade completed:

9 10 11 12

College/University

Institution Name

City

State (*if in US)

Country:

Did you graduate?

Yes No

Years completed:

1 2 3 4

Degree, cerificate, or diploma:

Major or field of study:

Major concentration:

Minor:

Technical/Other

Institution Name

City

State (*if in US)

Country:

Did you graduate?

Yes No

Years completed:

1 2 3 4

Degree, cerificate, or diploma:

Major or field of study:

Major concentration:

Minor:

Millitary

Branch:

Rank

Dates Served (mm/yyyy)
to

Licensure and Certification

Are you currently registered, certified, or licensed in your specialty?

Yes No

Type of License:

Date of issue (mm/yyyy):

NJ professional license number:

Date of expiry (mm/yyyy):

Certification:

Skills

List all equipment (office, trade laboratory) that you are able to operate:

Additional certifications and/or relevent coursework:

List all foreign languages in which you are fluent:

Personal Information

* Have you ever been disciplined or discharged for theft, unauthorized removal of company property or related offenses?

Yes No

If yes, please explain:

* Have you ever been discharged for fighting, assault or related offenses?

Yes No

If yes, please explain:

* Have you ever been disciplined or discharged for violating safety rules?

Yes No

If yes, please explain:

* Have you ever been disciplined or discharged for insubordination?

Yes No

If yes, please explain:

* Have you ever been disciplined or discharged for unsatisfactory performance?

Yes No

If yes, please explain:

* Have you ever been disciplined or discharged for incompetent practice or a related offense?

Yes No

If yes, please explain:

If you possess a license or certification, has your license or certification ever been suspended or revoked?

Yes No

If yes, please explain:

If you possess a license or certification, is your license or certification currently under review by the credentialing agency?

Yes No

If yes, please explain:

Authorization

* I certify that the information contained in this application is correct, and I understand that if an offer of employment is made to me it will be contingent upon the results of a post-offer medical examination which includes a background check, drug and alcohol testing, and receipt of satisfactory references. I realize that misrepresentation of facts called for in this application may result in a revocation of an offer of employment or dismissal after employment. I hereby authorize my present and past employers to furnish MPower Electrical Contractor with records of my employment.

I Agree

Notice

MPower Electrical Contractor is an equal opportunity/affirmative action employer. It is committed to the recruitment, employment and promotion of all individuals without regard to race, color, religion, creed, ancestry, affectional or sexual orientation, sex, genetic information, a typical hereditary cellular or blood trait, age, national origin, martial status, pregnancy, disability or handicapped status, gender identity or expression or for services in the United States Armed Forces.

NJ License #17065