Applicant InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Date of Birth* Date Format: MM slash DD slash YYYY Position Applied For*Full or Part Time?*Full TimePart TimeSalary Desired*How did you hear about us?*Do you have any friends or relatives that work here?*YesNoIf yes, please list:Do you have reliable transportation?*YesNoWould you be willing to work overtime if necessary?*YesNoIf offered employment, when will you be able to work?* Date Format: MM slash DD slash YYYY Have you ever been convicted of a felony?*YesNoIf yes, please explain:Employment HistoryCompany*Phone*Address*Supervisor*Job Title*Responsibilities*From* Date Format: MM slash DD slash YYYY To* Date Format: MM slash DD slash YYYY Reason for Leaving*May we contact your previous supervisor for a reference?*YesNoCompany*Phone*Address*Supervisor*Job Title*Responsibilities*From* Date Format: MM slash DD slash YYYY To* Date Format: MM slash DD slash YYYY Reason for Leaving*May we contact your previous supervisor for a reference?*YesNoCompanyPhoneAddressSupervisorJob TitleResponsibilitiesFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Reason for LeavingMay we contact your previous supervisor for a reference?YesNoResumeCertificationI certify that the information provided is truthful and accurate, I understand that providing false or misleading information will be the basis for the rejection of my application, or if employment commences, immediate termination. I authorize Truitt Electric to contact former employers regarding my employment. I authorize my former employees to fully and freely communicate information regarding my previous employment, performance and attendance.Signature*Date* Date Format: MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.