Saturday, May 19, 2012
You are here:  Employment Application

Kurz Electric Solutions, Inc.

APPLICATION FOR EMPLOYMENT

PRE-EMPLOYMENT QUESTIONNAIRE

EQUAL OPPORTUNITY EMPLOYER

 

Personal Information

NAME SOCIAL SECURITY NO.
STREET CITY STATE ZIP
PHONE NO. REFERRED BY

 

Employment Desired

POSITION DATE YOU CAN START SALARY DESIRED
IF THE DESIRED POSITION INVOLVES DRIVING A COMPANY VEHICLE, ANSWER THE QUESTION BELOW
DO YOU HAVE A VALID WISCONSIN DRIVERS LICENSE?
ARE YOU PRESENTLY EMPLOYED? IF SO, MAY WE CONTACT YOUR EMPLOYER?
HAVE YOU EVER APPLIED TO THIS COMPANY BEFORE IF SO, WHERE? WHEN? (approximately)

 

Education History

NAME AND LOCATION OF SCHOOL

YEARS

ATTENDED

DID YOU

GRADUATE?

SUBJECTS

STUDIED

GRADE SCHOOL
HIGH SCHOOL
COLLEGE

TRADE, BUSINESS OR

CORRESPONDENCE

SCHOOL

 

General Information

SUBJECTS OF SPECIAL STUDY/RESEARCH WORK OR SPECIAL TRAINING/SKILLS
U.S. MILITARY OR NAVAL SERVICE RANK

 

Former Employers (List Below Last Four Employers, Starting With the Most Recent First)

NAME AND ADDRESS OF

EMPLOYER

DATES EMPLOYED

SALARY POSITION REASON FOR LEAVING
FROM THROUGH

 

References (List the Names of Three Persons Not Related to You, Whom You Have Known at Least One Year)

NAME AND ADDRESS PHONE NO. BUSINESS YEARS KNOWN

 

Authorization

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand

that, if employed, falsified statements on this application shall be grounds for dismissal.

 

I authorize investigation of all statements contained herein and the references and employers 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 Kurz Electric Solutions, Inc.  from all liability from any damage that may result from utilization

of such information.

 

I agree that if I am offered employment by Kurz Electric Solutions, Inc. my employment will be employment "at will"

and that my employment can be terminated, with or without cause, and with or without notice, at any time.  I understand

that neither this application nor any other personnel form will constitute a contract for employment.  If hired, I agree,

as a condition of employment, to keep confidential and not disclose to anyone any information acquired during employment

which is of a confidential, proprietary or privileged nature.

 

I understand that Kurz Electric Solutions, Inc. is an Equal Opportunity Employer and does not discriminate in employment.

It is understood that no question on this application is used for the purpose of limiting or excusing any applicant's

consideration for employment on a basis prohibited by local, state or federal law.

 

I understand that my typed name below constitutes an original signature and authorizes Kurz Electric Solutions, Inc.

to obtain a printed or faxed copy of this authorization to be as valid as an original signature."

 

DATE SIGNATURE