Job Application - Kirby Electric

Kirby ElectricAbout UsCareersJob Application

We are an Equal Opportunity Employer and fully subscribe to the principles of Equal Employment Opportunity. Applicants and/or employees are considered for hire, promotion and job status, without regard to race, color, religion, creed, sex, marital status, national origin, age, physical or mental disability.
Name*
First Middle Last
Address*
Street Address Address Line 2 City State Zip Code
Phone*
Email*
What job are you applying for?*
1) General Information:
Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accommodation?*
2. Education & Training:
Education - Last grade completed
High School
Last High school Attended & Address
Name of School Address City State ZIP Code
Major Course of Study
Graduated or Obtained Degree?
Average Grade
College
College or University Name & Address
Name of School Address City State ZIP Code
Major Course of Study
Graduated or Obtained Degree?
Average Grade
College, University, or Other School & Address

Technical, Vocational, Graduate, etc.
College, University, or Other Name & Address
Name of School Address City State ZIP Code
Major Course of Study
Graduated or Obtained Degree?
Average Grade
List any Scholarships, academic honors, awards, or special achievements:
3. Skills
Please list any skills you have that are appropriate for the position you are applying for:
If required, will you work:
Check all that apply.
- Rotating shifts
- Overtime
- Saturdays
- Sundays
Position applying for:*
Please be specific.
Salary Requierments*
Please specify if the salary given is per hour, per month, etc.
State fully why you believe you are qualified for this position.*
Date you can start*
MM slash DD slash YYYY
Interests & Accomplishments
You may wish to list significant experience, interests & accomplishments gained while working as a volunteer or as a hobbyist that may be useful in the position(s) you are seeking. Names or organizations designating religion, race, etc. need not be mentioned.
Employment HIstory
Starting with your PRESENT or MOST RECENT EMPLOYER list in consecutive order ALL EMPLOYMENT for at least the past FOUR employers.
If currently employed, may we contact your employer?
1. Present or Most Recent Employer
Full Name of Company
Phone
Address
Street Address Address Line 2 City State ZIP Code
Name & Title of Supervisor
Title of Your Position
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
List jobs held, duties performed, skills used, and promotions while employed at this company:
Reason for Leaving:
2. Employer
Full Name of Company
Phone
Address
Street Address Address Line 2 City State ZIP Code
Name & Title of Supervisor
Title of Your Position
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
List jobs held, duties performed, skills used, and promotions while employed at this company:
Reason for Leaving:
3. Employer
Full Name of Company
Phone
Address
Street Address Address Line 2 City State ZIP Code
Name & Title of Supervisor
Title of Your Position
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
List jobs held, duties performed, skills used, and promotions while employed at this company:
Reason for Leaving:
4. Employer
Full Name of Company
Phone
Address
Street Address Address Line 2 City State ZIP Code
Name & Title of Supervisor
Title of Your Position
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
List jobs held, duties performed, skills used, and promotions while employed at this company:
Reason for Leaving:
Read Carefully:
I certify that the information contained in this application is correct to the best of my knowledge and understand that any misstatement or omission of information may result in denial of employment or discharge. I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties froma ll liability for any damage that may result from furnishing the same to you.*

Signature, by typing out your name your are certifying that the above statement is true and correct.
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