Call Us Now

Phoenix Metro Area: 623-937-3999 • Greater Tucson Area: 520-889-2804
Prescott, Cottonwood, Camp Verde, Sedona and Flagstaff: 928-775-4512
Albuquerque, Rio Rancho and Santa Fe: 505-888-7614
Las Cruces and El Paso: 915-629-9196

APPLICATION FOR EMPLOYMENT

(PRE-EMPLOYMENT QUESTIONNAIRE)
(APPLICATIONS ARE HELD FOR THIRTY DAYS ONLY)

Personal Information

Date:

LAST NAME

FIRST NAME

MIDDLE

SSN

PRESENT ADDRESS:

STREET

CITY

STATE

ZIP

PERMANENT ADDRESS:

STREET

CITY

STATE

ZIP

PHONE NUMBER: ARE YOU 18 YEARS OR OLDER? Yes No

EMPLOYMENT DESIRED

POSITION DESIRED: DATE YOU CAN START: SALARY DESIRED:

ARE YOU EMPLOYED NOW? Yes No

IF SO MAY WE INQUIRE OF
YOUR PRESENT EMPLOYER:

Yes No

HAVE YOU EVER APPLIED OR BEEN
EMPLOYED BY THIS COMPANY BEFORE?:

Yes No

WHEN?

EMPLOYMENT HISTORY
(LIST THE LAST FIVE YEARS. ACCOUNT FOR ANY PERIODS OF UNEMPLOYMENT.

DATES EMPLOYED FROM / TO	NAME AND ADDRESS OF EMPLOYER	SALARY START / END	REASON FOR LEAVING	NAME OF LAST SUPERVISOR

EDUCATION
	NAME AND LOCATION OF SCHOOL	YEARS ATTENDED	GRADUATED?	SUBJECTS STUDIED
HIGH SCHOOL:			Yes No
COLLEGE:			Yes No
TRADE, BUSINESS OR OTHER SCHOOL:			Yes No

GENERAL INFORMATION

LIST ANY SPECIALIZED TRAINING OR AREA OF STUDY:

ARE YOU A CURRENT MEMBER OF THE RESERVE OR NATIONAL GUARD?: Yes No

PERSONAL REFERENCES
GIVE THREE REFERENCES OF PERSONS NOT RELATED TO YOU

NAME	ADDRESS	PHONE / FAX E-MAIL	BUSINESS	YEARS ACQUAINTED

I authorize investigation of all information in this application and understand that misrepresentation or omission of the information requested is cause for rejection of this application. I further understand that by processing this application no guarantee of employment has been made and no inducement to apply has been offered. I also understand that if employed my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of the company or myself.


Applicants Signature	Date

AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER

FOR COMPANY USE

INTERVIEWED BY: _______________________________	DATE:	________________________

HIRED ( ) YES ( ) NO POSITION: _________________	DEPARTMENT / AREA:	________________________

SALARY / WAGE: _____________________
	START DATE:	________________________

APPROVED BY: __________________________________

Haskins Electric, LLC • 1414 N. 25th Avenue • Phoenix, Arizona 85009
Arizona Register of Contractors: C11217552 & L11252945 | State of New Mexico Contractors License: 94272
Texas Electrical Contractor License: 29503

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