Application – Xtreme Electric GA

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Employee Portal

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"Employer" *

Position Applying For *

Name *

First

Last

Desired Salary *

Do You Have A High School Diploma or GED? *

Yes
No

Hours (Check All That You Are Willing To Work) *

Full Time
Part Time
Days
Evenings
Swing
Graveyard
Weekends

Status *

Regular
Temporary

Are you authorized to work in the U.S. on an unrestricted basis? *

Yes
No

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) *

Yes
No

If Yes, Please Explain:

Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job? *

Yes
No

Can you perform these essential functions of the job with or without reasonable accommodation? *

Yes
No

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.

List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references.

Job Title #2 (copy) (copy)

Company Name (copy) (copy)

Supervisor Name (copy) (copy)

Duties (copy) (copy)

Reason For Leaving (copy) (copy)

May We Contact Your Present Employer? (copy) (copy)

Yes
No

Phone Number (copy) (copy)

Starting Salary (copy) (copy)

Ending Salary (copy) (copy)

Job Title #1

Company Name

Supervisor Name

Duties

Reason For Leaving

May We Contact Your Present Employer?

Yes
No

Phone Number

Starting Salary

Ending Salary

Job Title #2 (copy)

Company Name (copy)

Supervisor Name (copy)

Duties (copy)

Reason For Leaving (copy)

May We Contact Your Present Employer? (copy)

Yes
No

Phone Number (copy)

Starting Salary (copy)

Ending Salary (copy)

Job Title #2 (copy) (copy)

Company Name (copy) (copy)

Supervisor Name (copy) (copy)

Duties (copy) (copy)

Reason For Leaving (copy) (copy)

May We Contact Your Present Employer? (copy) (copy)

Yes
No

Phone Number (copy) (copy)

Starting Salary (copy) (copy)

Ending Salary (copy) (copy)

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application. *

Yes

I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party. (copy) *

Yes

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