Licensed Electrician Application

Your Initials *

I UNDERSTAND THAT WINTERS ELECTRIC REQUIRES A PRE-EMPLOYMENT DRUG TEST & BACKGROUND CHECK.

Name *

First

Middle

Last

List previous names used

Email Address *

Phone Number *

Referred By

Address *

City *

State *

Zip *

Drivers License State *

Drivers License Number *

Do you have a valid drivers license? *

Yes
No

Within the last 3 years, have you been convicted of a felony and/Or received any traffic violations, including a DWI/DUI? *

Yes
No

If you answered yes to the convicted felony and/Or traffic violations driving record, please explain.

Are you legally eligible to work in the US? *

Yes
No

Social Security Number *

Date of Birth *

Have you ever applied at Winters Electric before? *

Yes
No

If you applied before, on what date?

Date available to start *

Preference *

Full time
Part time

Special training / skills / qualifications *

Education History *

High School

College or Trade School

Where did you do your apprenticeship training? *

Name of Institution

When did you complete your apprenticeship training? *

Year Completed

Former Employers - List your last 3 employers, beginning with the most recent. (copy) *

Date *

First

Last

Salary *

Position *

Reason For Leaving *

Company 2 *

Date *

First

Last

Salary *

Position *

Reason For Leaving *

Company 3 *

Date *

First

Last

Salary *

Position *

Reason For Leaving *

Signature *

I AUTHORIZE YOU TO MAKE ANY INVESTIGATION AND TO OBTAIN ALL LAWFUL INFORMATION WHICH YOU DEEM NECESSARY IN CONNECTION WITH THIS APPLICATION AND TO CIRCULATE SUCH INFORMATION TO THE APPROPRIATE PERSONS WHO CONSIDER THIS APPLICATION. I REQUEST AND AUTHORIZE ALL REFERENCES AND FORMER EMPLOYEES TO SUPPLY INFORMATION ABOUT ME VERBALLY OR IN WRITING TO YOU. IN CONSIDERATION FOR THEIR FURNISHING SUCH INFORMATION, I HEREBY WAIVE ANY CLAIMS AGAINST THEM FROM THEIR FURNISHING SUCH INFORMATION. I CERTIFY THAT THE INFORMATION CONTAINED IN THIS OMISSION OF INFORMATION MAY CAUSE MY IMMEDIATE DISMISSAL OR REJECTION OF THIS APPLICATION. I AGREE THAT I MAY BE REQUIRED TO COMPLETE A MEDICAL EXAM FOR INITIAL AND CONTINUED EMPLOYMENT. I FURTHER UNDERSTAND THAT IN THE EVENT I AM EMPLOYED, SUCH EMPLOYMENT IS AT-WILL AND I AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITIVE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME, WITHOUT PRIOR NOTICE. NEITHER I NOR THE EMPLOYER HAVE AGREED ON ANY SPECIFIC PERIOD NOR ANY SPECIFIC PAY OR BENEFITS UNLESS OTHERWISE SET FORTH IN A SPECIFIC CONTRACT. I AND MY PRACTICE, COMMON LAW, COURT DECISION, OR STATUTE, NOW EXISTING OR CREATED LATER, INCLUDING ANY RELATED TO ALLEGATIONS OF VIOLATIONS OF STATE OR FEDERAL STATUTES RELATED TO DISCRIMINATION, AND ALL DISPUTES ABOUT THE VALIDITY OF THE ARBITRATION CLAUSE, SHALL BE EXCLUSIVELY RESOLVED UTILIZING A TWO-STEP ALTERNATE DISPUTE RESOLUTION (ADR) PROCESS AS FOLLOWS: 1) FIRST, THROUGH MEDIATION USING UTILIZING THE RULES AND MEDIATOR PROVIDED BY DISPUTE SYSTEMS, INC, A NEUTRAL ENTITY OR ITS SUCCESSOR AND 2) FAILING SETTLEMENT BY MEDIATION, WE AGREE THAT ALL CLAIMS AND DISPUTES INCLUDING THOSE OF JURISDICTION AND ARBITRATION, SHALL BE RESOLVED BY NEUTRAL BINDING ARBITRATION CONDUCTED BY THE NATIONAL ARBITRATION FORUM, (NAF), UNDER THE NAF CODE OF PROCEDURE IN EFFECT AT THE TIME ANY CLAIM IS MADE, THE DISPUTE RESOLUTION POLICY AND THE ARBITRATION RULES OF DISPUTE SYSTEMS INC. OR ITS SUCCESSOR, ANY AWARD OF THE ARBITRATOR(S) MAY BE ENTERED IN ANY COURT OF COMPETENT JURISDICTION. IN SIGNING THIS APPLICATION, I AM EXPRESSLY WAIVING ANY RIGHT TO TRIAL BY JURY OR JUDICIAL APPEAL. 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 TERMINATION.

Date *