APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer & Drug Free Workplace


Personal Data


Work Sought

Job Preference:CommercialOther
Seeking:Full TimePart Time

DO YOU HAVE THE LEGAL RIGHT TO WORK AND BE EMPLOYED IN THE UNITED STATES?YesNo


Education

Graduated?YesNo
Graduated?YesNo


Employment Record

Provide last 10 Years Employment / Electrical Experience:
List all prior employment during the past ten (10) years. Include gaps of unemployment or other periods of no work. Attach separate list if necessary.

Present or Recent Employer

Part TimeFull Time

Previous Employer

Part TimeFull Time

Previous Employer

Part TimeFull Time

Previous Employer

Part TimeFull Time

Additional Information

Do you have reliable transportation?YesNo

Have you been convicted of a crime? NoYes

Personal References

I hereby certify that the information contained in this application for employment is true and correct to the best of my knowledge and agree to have any of the statements verified by Welch Companies Inc. unless I have indicated to the contrary. I authorize the references listed above, as well as other individuals, including former employers, whom the Company contacts to provide the Company with all information concerning my employment and other pertinent information that they may have. Further, I release all parties from any and all liability for any damages that may result from furnishing such information to the Company as well as from the use or disclosure of such information by the Company, or any of its agents, employees ore representatives. I understand and agree that any misrepresentation, falsification or material omission of information on this application may result in my failure to receive an offer, or, if I am hired, a change in offer or my dismissal from employment. I understand and agree that the Company shall not be liable in any respect if my employment is terminated because of a misrepresentation, falsification, inability to verify or material omission of information on this application for employment. I understand and agree that any information provided to the Company shall become the exclusive property of the Company. It is agreed and understood that this application for employment in no way obligates the Company to employ me. I have the right to resign my employment at any time, for any reason or no reason. I also understand that the Company has the right to discharge me at any time, for any reason, with or without notice. I further understand that neither this application nor any written or oral communication by management made at the time of hire, or during the course of my employment, will be considered an employment contract between the Company and me.

I authorize the references listed above, as well as other individuals, including former employers, whom the Company contacts to provide the Company with all information concerning my employment and other pertinent information that they may have. Further, I release all parties from any and all liability for any damages that may result from furnishing such information to the Company as well as from the use or disclosure of such information by the Company, or any of its agents, employees or representatives.
YesNo

By submitting this applications I certify that I understand these conditions of employment and that all entries on this application are true and complete to the best of my knowledge.

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STATE AND FEDERAL LAW PROHIBITS DISCRIMINATION BECAUSE OF RACE, COLOR, RELIGION, SEX, AGE, MARITAL STATUS, NATIONAL ORIGIN, DISABILITY, DISABLED VETERAN OR VETERAN OF THE VIETNAM ERA.

Employment application effective for 90 days from the date of application signature.
Applicant must complete a new application if reapplying after 90 days.