PEC's Online Employment Application (Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status.)

Name (First, Middle Initial, Last) *

Today's Date (mm/dd/yyyy) *

Street Address *

City, State, Zip *

Home Phone *

Business Phone

Email:

Have you ever applied for employment with us? *

Yes

If yes, month and year (mm/yyyy)

If you have ever been employed with us give starting and ending dates

Are you legally eligible for employment in the United States? *

Yes

If you are under age 18, can you provide required proof of you eligibility to work?

Yes

Position Desired, please list any relevant skills or special training (ie. languages, machine operation, etc.)

Do you have any physical limitations which prevent you from doing the job for which you are applying? (if yes, explain)

When will you be available to begin work?

Education Information

High School (list all of the following: name and location of school, course of study, number of years completed, did you graduate, and degree or diploma)

College (list all of the following: name and location of school, course of study, number of years completed, did you graduate, and degree or diploma)

Other/Vocational Schooling (list all of the following: name and location of school, course of study, number of years completed, did you graduate, and degree or diploma)

Employment History for Latest Three Jobs (Please give accurate, complete full time and part time information. Start with present or most recent employer.)

List all of the following: Company Name, Address, Telepone Number, Job Title, Name of Supervisor, Ending Pay, Reason for Leaving

Dates Employed (mm/yyyy-mm/yyyy)

List all of the following: Company Name, Address, Telepone Number, Job Title, Name of Supervisor, Ending Pay, Reason for Leaving

Dates Employed (mm/yyyy-mm/yyyy)

List all of the following: Company Name, Address, Telepone Number, Job Title, Name of Supervisor, Ending Pay, Reason for Leaving

Dates Employed (mm/yyyy-mm/yyyy)

List any professional, trade, business or civic activities and offices held

You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or hadicap or other protected status.

References

Please give name, address and telephone number of three references who are not related to you and are not previous employers.

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