Please mail your completed application to:
Palazzo Brothers Electric, Inc
124-A Cleveland Road
Norwalk, Ohio  44857
Application For Employment
To print this application select the print option on your computer
or hold down the 'control' key and the 'P' key on your key board
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.
NAME ___________________________________________DATE OF BIRTH __________________SS#_________________

ADDRESS________________________________________CITY___________________STATE__________ZIP___________

PHONE_____________________________                   TODAYS DATE___________________


Are you at least 18 years of age ____Yes ____No                   If you are under 18 years of age please state your age ___________

Have you ever applied for a job with this Company before? ____Yes ____No

Have you ever worked at this Company before ____Yes ____No     

If yes, when and for how long?_______________________________________


Position for which you are applying:
____________________________________________________________________________________________________

Other positions for which you would like to be considered:

___________________________________________________________________________________________________

Salary Expected:   $________________ per_______________.

What experience or skills qualify you for work here?
____________________________________________________________________________________________________

____________________________________________________________________________________________________

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?                            _____Yes_____No


Have you served an apprenticeship  _____Yes _____No                                   If yes, how many years _______________________
                                                       
                                                     Tade______________________________________________________________________

If your application is considered favorably, on what date can you begin work?          ____________________________________
               
Is there any reason why we would not be able to call references or a former employer?  ____YES  ____NO

If yes, why not? _______________________________________________________________________________________

___________________________________________________________________________________________________
EDUCATION
SCHOOL NAME
ADDRESS
LAST YEAR
COMPLETED
DID YOU
GRADUATE?
High School
        
College
        
Other
Education
        
DATES
NAME AND ADDRESS OF
EMPLOYER
JOB TITLE
OR DUTIES
WEEKLY
SALARY
REASON FOR LEAVING
TELEPHONE NUMBER _____________________________ SUPERVISORS NAME ______________________________
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TELEPHONE NUMBER _____________________________ SUPERVISORS NAME ______________________________
PERSONAL REFERENCES  (Not former employers or relatives)
Are you willing and able to travel? ____YES  ____NO      If NO,  why not? ___________________________________________

___________________________________________________________________________________________________

Do you own a vehicle? ____YES ____NO      Make_________________Model___________________Year_______________

Will you be able to drive for the company?  ____YES ____NO  If NO, why not________________________________________

___________________________________________________________________________________________________

How is your driving record?  ______________________________       Would you submit to a drug test?____YES____NO


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                                                                           Signature of Applicant


EMPLOYMENT RECORD
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NAME AND ADDRESS
TELEPHONE
RELATIONSHIP AND
YEARS KNOWN
     
     
     
________________________________________________________