Wells & Tate Electric Company, Inc | Huntsville, Madison, Decatur, AL

PERSONAL INFORMATION
Last Name	Middle Name	First Name

Present Address	City	State/Zip

SSN	Drivers License #

Phone Number	Email Address

Are you at least 18 years old?		Yes No
Can you provide proof of your legal right to work in the U.S. if hired?		Yes No
Do you use tobacco products? (for job placement purposes)		Yes No
Have you ever been convicted of a felony?		Yes No
If Yes EXPLAIN

GENERAL INFORMATION
Are you able to carry out all necessary job assignments/functions and perform them in a safe manner?	Yes No
Can you work overtime and on weekends if necessary?	Yes No
Do you have a means of transportation to work if hired?	Yes No
Indicate if you have any Military Service:
In case of Emergency
Name
Address
Number
List Special Skills, Knowledge, Experience, Certifications or Licenses That you Possess

EMPLOYMENT DESIRED
Position Applying For:	Date You Can Start:	Desired Pay Rate:

Have you ever worked here before?	When & Where?	Do any of your relatives work here?

Are you currently employed?	If so, where?	May we contact your current employer?

List of any OSHA, SAFETY, or Equipment Training you have documentation for?