Print Application and send or fax to:
Eagle Electric, LLC
2441 Cinnabar Loop, Suite 200
Anchorage AK 99507
(907) 344-7121
Fax (907) 344-0827
| Full Name
|
Date
|
| Social Security Number
|
Phone Number
|
| Address
|
Message Phone
|
| Position Applying For: _______________________ | Full Time _______ | Part Time _____ | |
| Do you have a current State of Alaska fitness card? | Yes * ______ | No _____ | |
| *If yes, what is the number? ___________________ |
Expiration Date _________________ |
||
| Wage Expected _______________________ |
Available Start Date ______________ |
||
| Health Status (Please report any condition
concerning the back, knee, joints, etc.)
__________________________________________________________________________ |
|||
| Have you filed any claims for worker's compensation? |
Yes ______ |
No _____ |
|
| If Yes, please describe
__________________________________________________________________________ |
|||
| Have you ever been convicted of a crime? |
Yes ______ |
No _____ |
|
| If Yes, please describe
__________________________________________________________________________ |
|||
| Do you have transportation? |
Yes ______ |
No _____ |
|
| Car Make ______________________________ |
Model _______________________ |
||
| Driver's License Number ___________________ |
Expires ______________________ |
||
| Do you have a clean driving record? |
Yes ______ |
No _____ |
|
| Please attach current driving record | |||
| If no, please describe all driving violations:
__________________________________________________________________________ |
|||
Employment History
(Please list all present and past employment, starting with
your present or last employer.)
| Name & Address of Company | From | To | Starting Salary Monthly/Hourly |
Last Salary Monthly/Hourly |
| ______________________________________
______________________________________ |
| Supervisor's Name _______________________ | Phone Number _____________ |
| Position/Duties:
_____________________________________________________________
__________________________________________________________________________ |
|
| Why did you leave?
__________________________________________________________
__________________________________________________________________________ |
|
| Name & Address of Company | From | To | Starting Salary Monthly/Hourly |
Last Salary Monthly/Hourly |
| ______________________________________
______________________________________ |
| Supervisor's Name _______________________ | Phone Number _____________ |
| Position/Duties:
_____________________________________________________________
__________________________________________________________________________ |
|
| Why did you leave?
__________________________________________________________
__________________________________________________________________________ |
|
| Name & Address of Company | From | To | Starting Salary Monthly/Hourly |
Last Salary Monthly/Hourly |
| ______________________________________
______________________________________ |
| Supervisor's Name _______________________ | Phone Number _____________ |
| Position/Duties:
_____________________________________________________________
__________________________________________________________________________ |
|
| Why did you leave?
__________________________________________________________
__________________________________________________________________________ |
|
| *If you need additional space, please use the back of this paper. | |
Education Record
| Name & City/State of School | GPA | No. Years at School |
Degree |
| Elementary: | |||
| High School: | |||
| Junior College: | |||
| College: |
| Other Schooling of Specialized Training:
__________________________________________
__________________________________________________________________________ |
| Why would you like a job with this company?
________________________________________
__________________________________________________________________________ |
| Is there anything else you would like us to know about you?
_____________________________
__________________________________________________________________________ |
Personal References
(Please do not include former employers or relatives)
| Name & Occupation | Address | Phone Number |
| 1) | ||
| 2) | ||
| 3) | ||
Applicant Please Read Carefully
|
I certify that the facts contained in this application are true and complete to the best of my knowledge. By my signature below, I authorize Eagle Electric, L.L.C. to contact my former employers, work associates, and schools for reference purposes, and I authorize my former employers, work associates, and schools to provide such information without recourse. I further understand that falsified statements on this application can be considered as sufficient cause for discharge. |
| ______________________________________________ |
___________________________ |
| Signature of Applicant | Date |