EMPLOYMENT APPLICATION

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

DATE:

First Name:

Middle Name:

Last Name:

Present Address:

Street (cont):

City:

State:

Zip:

How long:

Telephone:

() -

Alternate Telephone:

() -

other e-mail:

will not be released

Please list age:

Have you ever applied for Employment with us?:

Yes

Referred by:Specify name and position:

How Did You Learn About Us? friend, newspaper, employee:

Are you legally eligible for Employment in the U.S.?:

Yes

If Yes, valid until Month/Year:

(MM-YYYY)

Position applied for:

Salary desired:

Days/hours available to work

No Pref:

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

How many hours can you work weekly?:

Are you willing to work overtime?:

Yes

Can you work nights?:

Yes

Employment desired:

FULL-TIME ONLY

PART-TIME ONLY

FULL- OR PART-TIME

When available for work?:

TYPE OF SCHOOL:
NAME OF SCHOOL:
Street:
Street (cont):
City:
Country:
Zip:
NUMBER OF YEARS COMPLETED:
MAJOR & DEGREE:
State:

TYPE OF SCHOOL:
NAME OF SCHOOL:
Street:
Street (cont):
City:
Country:
Zip:
NUMBER OF YEARS COMPLETED:
MAJOR & DEGREE:
State:

HAVE YOU EVER BEEN CONVICTED OF A CRIME?:

Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation:

DO YOU HAVE A DRIVER'S LICENSE?:

Yes

What is your means of transportation to work?:

Driver's license last 4 numbers:

State of issue:

License Type:

Expiration date:

Have you had any accidents during the past three years?:

Yes

How many?:

Have you had any moving violations during the past three years?:

Yes

How many?:

ADDITIONAL TRAINING

List any special training or skills, applicable to the position:

Please list two references other than relatives or previous employers.

Name:
Position:
Company:
Telephone:	() -

Name:
Position:
Company:
Telephone:	() -

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

Additional Information:

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES?:

Yes

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?:

Yes

Specialty:

Date Entered:

Discharge Date:

Work Experience

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give the firm name.

Name of Employer:
Phone number:	() -
Name of last supervisor:
Employment dates
From:
To:
Pay or Salary
Start:
Final:
Your last job title:
Reason for leaving: (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.:

Name of Employer:
Phone number:	() -
Name of last supervisor:
Employment dates
From:
To:
Pay or Salary
Start:
Final:
Your last job title:
Reason for leaving: (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.:

May we contact your present employer?:

Yes

Did you complete this application yourself?:

Yes

If not, who did?:

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Murphy Electric (hereinafter called "the Company"), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Murphy Electric, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President/General Manager of the Company. Both the undersigned and Murphy Electric, may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I further understand that my employment with the Company shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Signature of applicant:

Date:

This Company is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.