Electrical Design Director

First Name

Last Name

M.I.

Address

Phone Number

Date Available

Social Security Number

Date of Birth

Position Applying For

Desired Salary ($)

Are you a U.S. Citizen?

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

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Will you require sponsorship now or in the future?

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Have you ever been convicted of a felony?

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If yes, when?

If yes, explain

High School

High School Address

High School From

High School To

Did you graduate high school?

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High School Diploma

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College

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College From

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Did you graduate college?

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Reference 1 Full Name

Reference 1 Relationship

Reference 1 Company

Reference 1 Phone

Reference 1 Address

Reference 2 Full Name

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Reference 2 Company

Reference 2 Phone

Reference 2 Address

Reference 3 Full Name

Reference 3 Relationship

Reference 3 Company

Reference 3 Phone

Reference 3 Address

Company 1

Company 1 Phone

Company 1 Address

Company 1 Supervisor

Company 1 Job Title

Company 1 Responsibilities

Company 1 From

Company 1 To

Company 1 Reason for Leaving

May we contact your previous supervisor for a reference from company 1?

Yes No

Company 2

Company 2 Phone

Company 2 Address

Company 2 Supervisor

Company 2 Job Title

Company 2 Responsibilities

Company 2 From

Company 2 To

Company 2 Reason for Leaving

May we contact your previous supervisor for a reference from company 2?

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Company 3

Company 3 Phone

Company 3 Address

Company 3 Supervisor

Company 3 Job Title

Company 3 Responsibilities

Company 3 From

Company 3 To

Company 3 Reason for Leaving

May we contact your previous supervisor for a reference from company 3?

Yes No

Branch

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Rank at Discharge

Type of Discharge

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Disclaimer

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.