Lamp & Light Electric Employment Application
First Name: *
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Last Name: *
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Nickname:
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Home Address: *
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City: *
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State: *
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Zip Code: *
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Email Address: *
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Phone Number: *
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Social Security Number: *
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Date Of Birth: *
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Driver's License Number *
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Driver's License State: *
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Driver's License Class: *
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Driver's License Expiration Date: *
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Gender: *
Marital Status: *
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US Citizen: *
Are You Authorized To Work In The US: *
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Job Title Of Position You Are Applying For: *
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Desired Pay: *
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Position Applied For: *
If yes, explain:
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Emergency Contact Name: *
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Emergency Contact Phone Number: *
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Emergency Contact Relationship: *
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Education
High School you attended:
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Years you attended high school:
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College or trade school you attended:
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Years you attended:
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Did you graduate with a degree
Degree:
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Previous Employment
Please list past and current employers
Company:
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Job Title:
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Responsibilities:
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Dates you held this position:
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Reasons for leaving:
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Supervisor:
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Supervisor's Phone Number:
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May we contact your previous supervisor?
Company:
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Job Title:
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Responsibilities:
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Dates you held this position:
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Reasons for leaving:
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Supervisor:
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Supervisor's Phone Number:
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May we contact your previous supervisor?
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Full Name: *
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Date: *
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