Professional Electrical Services, Inc.

Employment
Are you interested in joining the Professional Electric Services, Inc. team? We are always looking for team players who thrive on innovation. Please fill out the application below.

Personal Information

Name (Last Name First)

Social Security Number

Present Address	City	State	Zip
Permanent Address	City	State	Zip

Phone Number

Referred By

Employment Desired

Position

Date You Can Start

Salary Desired

Are You Employed?

Yes
No

If So, May We Inquire Your Present Employer?

Yes
No

Ever Applied to This Company Before?

Yes
No

Where?

When?

Education History

	Name & Location	Years Attended	Graduate?	Subjects Studied
Grammar School
High School
College
Trade, Business or Correspondence School

General Information

Subjects of Special Interest

U.S. Military or Naval Service

Rank

Former Employers (List Below Last Four Employers, Starting With Last One First)

Date MM/YY	Names & Addresses of Employers	Salary	Position	Reason For Leaving
From To
From To
From To
From To

References (Give below references who are non-family members and whom you have known for at least one year.)

Name	Address	Business	Years Known

Authorization
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previously employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

Date	Name (This is considered a digital signature)