1: IDENTIFYING DATA
 

Date:


  

First Name:

Present Address:

State:

Phone Number:

Former Address:

State:

How long ?

Last Name :

City:

Zip Code:

Are you legally employable in the U.S?

City:

Zip Code:
   

2: EMPLOYMENT INTEREST

   

Position of Interest:

Your long-range career objective.


Were you referred to us?
If yes, by whom?

Additional Information:
 
3: EDUCATION
 
Highest grade or number of years completed?
Grade School

 High School
 Jr. College
 College
   
Names and locations of schools attended?
High School City/State Did You Graduate? Course of study or
Degree Earned?
       
College(s) City/State Did You Graduate? Course of study or
Degree Earned?
       
 
List any special schooling: (skills, certifications, computer proficiency, etc..)
 
4: Employment History
 
Employer Name:
 Address:
 Position:

Month/Year-From-To:

Earnings:
         
Supervisor:
 City, State & Zip:
, , 		Phone Number:
  
 
Reason for leaving:
 
 
Employer Name:
 Address:
 Position:

Month/Year-From-To:

Earnings:
         
Supervisor:
 City, State & Zip:
, , 		Phone Number:
  
 
Reason for leaving:
 
Which of the jobs best did you like best and why?
 

Do you prefer a job with a variety of duties?

What kind of work would you like most to do?
 

5: Personal Background:

 
What are your hobbies and interets?
 
References: Give name. address and telephone of two local references other than two relatives or former employers.
 
Industry References: Do you know other people in the electrical industry? Give name and company.