On line Application for Employment  
The following information is requested to help us make the best possible placement within Palazzo Brothers Electric, Inc.
All portions of this application pertaining to you must be completed.  We appreciate the time you spend in filling in this
application form.
Palazzo Brothers Electric, inc, in accordance with the State and Federal laws, does not discriminate on the basis of age, race, sex, religion, color national origin,
physical or mental disability or union affiliation.
_______________________________________________________________________________________________________________________________
Please fill in the application and click on the SUBMIT button at the bottom of the page.  If you are considered for employment you will be
required to fill out a paper copy of the application for our records.


Name

Address

City


State


Phone

Todays date
Are you at least 18 years of age
If you are under 18 state your age
Have you ever worked for this Company before?
If yes, when and for how long
ZIP
Position for which you are applying:
Other positions for which you would like to be considered:
Salary Expected:
What experience or skills qualify you for work here?
Previous work history
Name and Address of Employer
Dates worked
May we
contact  this
company
Ending wage
Reason for leaving
Job Title or Duties
Phone
Supervisors Name
Phone
Supervisors Name
Supervisors Name
Phone
Phone
Supervisors Name
Education History
Schold name and address
Last Year Completed
Degree or Studies
High School
College
Trade School
Personal References (Do not use former employers or relatives)
Name, Address, Telephone                                                                  Relationship and Years Known
May we contact  your references?
The normal working hours of the Company vary and encompass different shifts, including Saturdays.  Without
indicating  the need for any absences for religious practices during the normal working hours, are you otherwise
available to work  during these hours?                            
Have you served an apprenticeship
If yes, how many years and what Trade
If your application is considered favorably, on what date can you begin work?
Are you willing and able to travel?
If no, why not
Do you own a vehicle?
Make, Model and Year
Will you be able to drive for the Company?
If no, why  not
How is your driving record?
Would you submit to a drug test?
PLEASE READ THE LANGUAGE BELOW CAREFULLY, SHOULD YOU HAVE ANY QUESTIONS
REGARDING THIS LANGUAGE, PLEASE SEEK ASSISTANCE PRIOR TO SIGNING THIS DOCUMENT.

I certify that the information contained in this application is true, accurate and complete.  I understand that falsification of the Employment
Application in any detail may result in disqualification from further consideration, or if hired, immediate dismissal without notice and
ineligible for reemployment.  As a condition of employment, I understand the Company reserves the privilege to thoroughly investigate
(background check) and verify all information contained in this Employment Application, including but not limited to contacting any of the
above mentioned employers, supervisors, and references.  I agree to indemnify and save the Company from and against any liabilities,
claims, attorneys fees, costs, causes of action or other liability arising directly or indirectly from, or associated with this Employment
Application.

I agree to conform to the rules and regulations of the Company, and I understand that my employment and compensation can be
terminated, without cause, at any time, at the option of either the Company or myself.  I further understand that no personnel recruiter or
interviewer or other representative of the Company, other than it's President or Vice President has any authority to enter any agreement
for employment for any specified  period of time, or to make any agreement contrary to the foregoing.

If I am hired on a full-time basis, I agree to work only for Palazzo Brothers Electric, Inc. and will not be employed by any other employer(s).
Date
Please retype your name here as your signature
Click her for printable view