270-696-0868

service.qualifiedelectric@gmail.com

Qualified Electric, LLC

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QUALIFIED ELECTRIC

Employment Application

Qualified Electric is an Equal Opportunity Employer

Applicant Information

Full Name *

Date *

Phone Number *

Email Address *

Address *

City *

State *

Zip *

Are you at least 18 years old? *

Yes No

Do you have a valid driver's license? *

Yes No

Driver's License Number

State Issued

Position Information

Position Applying For *

Apprentice Electrician Journeyman Electrician Electrician Helper Foreman Other

If Other, please specify

Desired Start Date

Desired Pay Rate

Are you legally authorized to work in the United States? *

Yes No

Work Experience

Current / Most Recent Employer

Company

Position

Supervisor

Phone Number

Dates Employed

Reason for Leaving

Previous Employer

Company

Position

Supervisor

Phone Number

Dates Employed

Reason for Leaving

Electrical Experience

Years of Electrical Experience *

Type of Work (check all that apply)

Residential Commercial Industrial Service Work New Construction Remodeling

Describe your electrical experience

Certifications & Licenses

Journeyman License Master Electrician License OSHA 10 OSHA 30 CPR / First Aid

Other Certifications

References

Reference #1

Name

Phone

Relationship

Reference #2

Name

Phone

Relationship

Reference #3

Name

Phone

Relationship

Additional Information

Have you ever been convicted of a felony that has not been expunged? *

Yes No

If yes, please explain

Applicant Certification

I certify that all information provided in this application is true and complete to the best of my knowledge. I understand that any false information may result in disqualification from employment or termination if hired.

Applicant Signature (type full name) *

Date *

Qualified Electric
7393 Elizabethtown Road
Leitchfield, KY 42754
Phone: (270) 696-0868

"Providing quality electrical services with integrity, professionalism, and safety."