All information will be kept in strictest confidence.
We are a drug free workplace and an equal opportunity employer.

*= Required Information
Personal Data

* Your Name (last, first, middle):

* Your Email:

* Social Security Number:

* Street Address:

* City, State, Zip:

* Home Phone:

Message Phone or Cell:

* If employed, can you provide proof of U.S. citizenship?  Yes No N/A

* Are you 18 or over?  Yes No

* Position(s) applying for

Referred by:

* Do you hold a current Journeyman Electricians Comp. Card?  Yes No

Date exam was taken?

Testing Score?

Proctored Exam?  Yes No

* If employed, will you comply with the company's Drug Free work program and Testing?  Yes No

* If employed, will you be able to travel and work on projects throughout the State of Florida?  Yes No

* Do you hold a current Florida Drivers license?  Yes No

* What is your Drivers License #?

* If employed, will you participate in continuing education programs sponsored by the company?  Yes No

Education Record

* High School:

* Address:

* Dates attended:

* Degrees or diplomas:

If you have completed other education, please indicate:

College/University:

Address:

Dates attended:

Degrees or diplomas:

Trade or Technical Training:

Address:

Dates attended:

Degrees or diplomas:

Military Service

* Have you served in the military?  Yes No If yes, please complete:

Branch of service:

Dates of service:

Duties/special training:

Employment History - Begin with most recent employer.

* Have you been employed before, or are you currently employed?  Yes No If yes, please complete the following:

1. Last or Current Employer:

Dates of employment:

Address:

City, State, Zip:

Phone:

Beginning Salary:

Ending Salary:

Title/duties:

Manager's name:

Why did you leave?:

2. Employer:

Dates of employment:

Address:

City, State, Zip:

Phone:

Beginning Salary:

Ending Salary:

Title/duties:

Manager's name:

Why did you leave?:

3. Employer:

Dates of employment:

Address:

City, State, Zip:

Phone:

Beginning Salary:

Ending Salary:

Title/duties:

Manager's name:

Why did you leave?:

4. Employer:

Dates of employment:

Address:

City, State, Zip:

Phone:

Beginning Salary:

Ending Salary:

Title/duties:

Manager's name:

Why did you leave?:

5. Employer:

Dates of employment:

Address:

City, State, Zip:

Phone:

Beginning Salary:

Ending Salary:

Title/duties:

Manager's name:

Why did you leave?:

6. Employer:

Dates of employment:

Address:

City, State, Zip:

Phone:

Beginning Salary:

Ending Salary:

Title/duties:

Manager's name:

Why did you leave?:

Personal Data
* Have you been convicted of a crime (other than traffic violations) or been imprisoned during the last seven years? A conviction will not necessarily bar you from employment.  Yes No
If yes, explain.

* Any friends or relatives employed by Gaudette Electric, Inc.?  Yes No If yes, their name(s):

* Do you have any physical or mental disability that may limit your performance in the job you are applying for?  Yes No
If so, what can be done to accommodate your limitation?

References
List two professional references who are familiar with the quality of your work, have worked directly with you, and have known you at least two years.

* 1. Name:

* Work phone:

* Home phone:

* Street Address:

* City, State, Zip:

* Relationship:

* 2. Name:

* Work phone:

* Home phone:

* Street Address:

* City, State, Zip:

* Relationship:

Required
The information provided in this Application for Employment is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

If you decide to engage an investigative consumer reporting agency to report on my credit and personal history I authorize you to do so. If a report is obtained you must provide, at my request, the name of the agency so I may obtain from them the nature and substance of the information contained in the report.

* I agree to the above:

* Typing your full name in the following space constitutes your legal signature:

Today's date:

Gaudette Electric, Inc.
P O Box 2820, Homosassa Springs, FL 34447-2820 USA
Florida State License #EC0001149

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