National Electrical Contractors Association - North Texas

An Equal Opportunity Employer - Applicants will not be discriminated against based on race, color, national origin, religion, age (over 40), sex, disability, veteran status, citizenship, genetic information or any other characteristic protected by federal, state or local law.

Applicant Information

Last Name

First

M. I.

Street Address

Apartment / Unit

City

State

Zip Code

Phone (999)999-9999

E-mail Address

Date Available (mm/dd/yyyy)

Desired Rate of Pay

Position Applied for

Full Time

Part Time

Are you a citizen of the United States?

Yes

No

If no, are you legally authorized to work in the U.S.?

Yes

No

Have you ever been convicted of a felony? (Conviction of a felony does not automatically disqualify an applicant for employment)	Yes	No	If Yes, explain
You have been provided with information concerning the essential functions of the job for which you have applied. Can you preform those functions with or without reasonable accommodation?	Yes	No

Employment - Last 5 years experience in the electrical trade (Enter Last Job First)

Company	Number of Employees	Date To (mm/dd/yyyy)	Date From (mm/dd/yyyy)	Title or Kind of Work	Wages	Reason for Leaving

Military Service

Branch

From (mm/dd/yyyy)

To (mm/dd/yyyy)

Rank at Discharge		Type of Discharge
If other than honorable, explain

Education

High School / Address

Did you graduate or receive an equivalent degree?

Yes

No

Degree

College / Address

Did you graduate?

Yes

No

Degree

Trade School / Address

Did you graduate?

Yes

No

Degree

Did you serve an electrical apprenticeship?"

Yes

No

Where?

How long?

Any other type of electrical education

Special Training or Skills

References

Please list three professional references

Full Name		Relationship
Company		Phone (999)999-9999
Address
Full Name		Relationship
Company		Phone (999)999-9999
Address
Full Name		Relationship
Company		Phone (999)999-9999
Address

Disclaimer and signature

I understand I am not applying for employment with NECA. I understand NECA is accepting my application for employment with a member of NECA. I authorize NECA to allow NECA-Member Employers to receive and review this application for employment. “I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, any omissions or misrepresentations of any information provided or requested will be grounds for withdrawal of my application from further consideration for employment, or termination of my employment if the omission or misrepresentation is discovered after hire. I authorize NECA and/or any NECA-Member Employer to investigate all statements contained herein and the references listed above to give either any and all information concerning my previous employment and any pertinent information they may have personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to either NECA and/or its Member Employers. I understand and agree that, if hired, I will be an at-will employee. That means my employment is for no definite period and may, regardless of the date of payment of my wages and/or salary, be terminated at any time without any prior notice. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disability Act (ADA) and other relevant federal and state laws. I understand that part of the application process may include submitting to a drug test to determine the use of illegal drugs. I understand that positive findings will result in immediate disqualification and the removal of my name for consideration for the position for which I am applying. I hereby agree to submit to such tests and release the results. I understand that I will be required to provide approved documentation that verifies my right to work in the United States upon employment. I hereby acknowledge that I have read and understand the above statements. Electronic submittal of this application shall require no signature. ” NOTE: Applications are valid for [45] days after being submitted. After [45] days, you should re-apply if you are interested in obtaining employment with a NECA-Member Contractor.

Date (mm/dd/yyyy)