American Light/Design Electric
Human Resources Department
4401 Westgate Boulevard #310 Austin, TX 78745
512-440-7985

EMPLOYMENT APPLICATION

American Light and Design Electric are Equal Opportunity Employers. Individuals requiring reasonable accommodations to complete the application and/or interview process should contact the Human Resources Department

Personal Information

Name (Last name,First name,Middle Initial) :
Current address: :	Street	City	State	Zip
Permanent address: :	Street	City	State	Zip
Phone # :
Mobile Phone # :
Pager # :
Email Address :
Referred By :
Social security number :
Driver’s license # :

Employment Information

Education, Skills, Qualifications

GRAMMAR SCHOOL
NAME/LOCATION OF SCHOOL
# OF YRS ATTENDED
DID YOU GRADUATE?	NO YES
SUBJECTS/MAJOR
HIGH SCHOOL
NAME/LOCATION OF SCHOOL
# OF YRS ATTENDED
DID YOU GRADUATE?	NO YES
SUBJECTS/MAJOR
COLLEGE
NAME/LOCATION OF SCHOOL
# OF YRS ATTENDED
DID YOU GRADUATE?	NO YES
SUBJECTS/MAJOR
TRADE/BUSINESS SCHOOL
NAME/LOCATION OF SCHOOL
# OF YRS ATTENDED
DID YOU GRADUATE?	NO YES
SUBJECTS/MAJOR

SUBJECTS OF SPECIAL STUDY/RESEARCH WORK OR SPECIAL TRAINING AND SKILLS – CHECK ALL THAT APPLY:


Driver’s License - (Check one):	Class C Commercial
Journeyman’s License:	NO YES
Master’s License(s)	NO YES
Master’s License(s) LIST CITIES:

US MILITARY OR NAVAL SERVICE:
RANK:

Employment History

List your employers below, starting with the most recent first.


DATES: FROM / TO
NAME/ADDRESS
SALARY
POSITION
REASON FOR LEAVING

DATES: FROM / TO
NAME/ADDRESS
SALARY
POSITION
REASON FOR LEAVING

DATES: FROM / TO
NAME/ADDRESS
SALARY
POSITION
REASON FOR LEAVING

DATES: FROM / TO
NAME/ADDRESS
SALARY
POSITION
REASON FOR LEAVING

References

REFERENCE #1
NAME
TELEPHONE
NUMBER OF YEARS KNOWN
REFERENCE #2
NAME
TELEPHONE
NUMBER OF YEARS KNOWN
REFERENCE #3
NAME
TELEPHONE
NUMBER OF YEARS KNOWN
REFERENCE #4
NAME
TELEPHONE
NUMBER OF YEARS KNOWN .

I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, COMPLETE, AND CORRECT.

· I UNDERSTAND THAT IF ANY OF THE INFORMATION I HAVE PROVIDED ON THIS APPLICATION FOR EMPLOYMENT IS FOUND TO BE FALSE, INCOMPLETE OR MISREPRESENTED IN ANY RESPECT, IT WILL BE SUFFICIENT CAUSE TO EITHER NULLIFY CONSIDERATION OF THIS APPLICATION FOR EMPLOYMENT OR CONSTITUTE GROUNDS FOR IMMEDIATE TERMINATION OF EMPLOYMENT WHENEVER IT IS DISCOVERED.

· I AUTHORIZE THE INVESTIGATION OF ALL STATEMENTS CONTAINED ON THIS APPLICATION, AND AUTHORIZE THE REFERENCES AND EMPLOYERS LISTED TO GIVE AMERICAN LIGHT AND DESIGN ELECTRIC ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION, AND RELEASE AMERICAN LIGHT AND DESIGN ELECTRIC FROM ALL LIABILITY FOR ANY DAMAGE WHICH MAY RESULT FROM THE UTILIZATION OF SUCH INFORMATION.

· I UNDERSTAND THAT TEXAS IS A RIGHT TO WORK STATE AND THAT IF I AM HIRED, I AM FREE TO RESIGN AT ANY TIME, WITH OR WITHOUT CAUSE OR PRIOR NOTICE, EXCEPT AS MAY BE REQUIRED BY LAW. THIS APPLICATION DOES NOT CONSTITUTE AN AGREEMENT FOR EMPLOYMENT.

· I UNDERSTAND THAT THIS APPLICATION WILL REMAIN ACTIVE FOR ONLY 30 DAYS. AT THE END OF THAT PERIOD, SHOULD I NOT BE HIRED BY AMERICAN LIGHT AND/OR DESIGN ELECTRIC, AND I STILL WISH TO BE CONSIDERED FOR EMPLOYMENT, I MUST RE-APPLY, AND FILL OUT A NEW APPLICATION.

· I UNDERSTAND THAT AMERICAN LIGHT AND DESIGN ELECTRIC DO NOT UNLAWFULLY DISCRIMINATE IN EMPLOYMENT AND NO QUESTION ON THIS APPLICATION IS USED FOR THE PURPOSE OF LIMITING OR EXCUSING ANY APPLICANT FROM CONSIDERATION FOR EMPLOYMENT ON A BASIS PROHIBITED BY ANY APPLICABLE STATE, LOCAL OR FEDERAL LAW.

· APPLICATIONS WHICH ARE IMPROPERLY FILLED OUT WILL BE REJECTED.

I certify that I have read, fully understand and accept all terms of the foregoing applicant statement.

Which Company Are You Applying With? :	American Light Design Electric
What position are you applying for? :
Have you ever applied to this company before? :	NO YES
If yes, when & where? :

Are you currently employed? :	NO YES
If yes, may we contact your employer? :	NO YES

Date you can begin work :
Desired salary :
Type of employment desired :

Are you legally eligible for employment in this country? :	NO YES

Have you ever plead “guilty” or “no contest” to, or been convicted of a crime? :	NO YES
If so, please provide date(s) and offense :
	Answering “yes” to this question does not constitute an automatic bar to employment. Factors such as date, seriousness of offense, rehabilitation, and position applied for will be taken into account.