Personal Data

Employment Interests

Education (Other than Military)

Work Experience

Employment History

U.S. Military Status and Record

References

THIS APPLICATION MUST BE FILLED OUT BY THE APPLICANT ONLY. ALL INFORMATION WILL BE REGARDED AS CONFIDENTIAL. THIS APPLICATION WILL BE RETAINED IN AN ACTIVE FILE FOR A PERIOD OF SIX MONTHS. THEREAFTER, IF YOU STILL DESIRE EMPLOYMENT WITH IBEW LOCAL #481 YOU MUST REAPPLY.

EXCLUDE ANY REFERENCE WHICH MAY REVEAL OR TEND TO REVEAL YOUR RACE, COLOR, RELIGION, NATIONAL ORIGIN, CREED, AGE, OR MARITAL STATUS

Phone
Cell Phone
E-Mail

Name
Social Security No.

Last
First
Middle Initial

Address
Yrs.
Mos.

No.
Street
City
State
Zip
How Long?

Former Address
Yrs.
Mos.

No.
Street
City
State
Zip
How Long?

Are you related to any employee of the IBEW Local #481?
Yes
No

Do you own a car?
Yes
No

Names of relatives in our employ

In case of emergency who should be notified?

Address
City
State
Zip

Have you ever been convicted of a felony?
Yes
No

Do you have a valid drivers license?
Yes
No

In case of emergency who should be notified?
Date you can start
Salary desired

Who referred you?
Ever worked for any IBEW L.U.?
When?
Where?

Scholastic honors, scholarships, assistantships, etc.

Met education expenses
Working
%
GI Bill
%
Parents
%
Scholarships
%
Other
%

Attending school now?
Yes
No
Where?

Schools	Federal Buildings	Fire Houses	Libraries	State Buildings	Prevailing Wage/ Common Wage Jobs

Name and Address of Present Employer
Employed:
From

Name of Your Supervisor
May we contact Him/Her?
Your Last Wage Rate?

Yes
No
/Hr.
/Wk.

Describe your Duties

Your reason for leaving
Presently Employed
Layoff

Explain

Name and Address of Past Employer
Employed:
From

Name of Your Supervisor
May we contact Him/Her?
Your Last Wage Rate?

Yes
No
/Hr.
/Wk.

Describe your Duties

Your reason for leaving
Presently Employed
Layoff

Explain

Name and Address of Past Employer
Employed:
From

Name of Your Supervisor
May we contact Him/Her?
Your Last Wage Rate?

Yes
No
/Hr.
/Wk.

Describe your Duties

Your reason for leaving
Presently Employed
Layoff

Explain

Present Selective Service Classification

Are you a veteran of the Vietnam Era?

4-Y or 4-F Please indicate a reason

(8-5-64 through 5-7-75)
Yes
No

Active Duty Dates
Rank Held

Branch of Service
From
To
Entry
Release
Type of Duty

Do you have Reserve or Guard obligations?
How long?

Service School Attended
Was separation due to a disability or aggravated in line of duty?

Type of School

Name and Address of School

Dates
From

Did you
Graduate?

Degree
Granted

Major Studies

High School

College or
University

Graduate
School

Electrical
Apprenticeship
(ABC, IEC, etc.)

Other-Trade/
Vocational, etc.

Give below the names of two personal references. (These references should be businessmen, professionals, teachers, or close personal acquaintances, not former employers or relatives.) It is to the applicant's advantage to give personal references which are most accessible.

Name and Occupation	Yrs. Known	Business Address OR	Home Address
		Street Address City State Zip	Street Address City State Zip
		Street Address City State Zip	Street Address City State Zip
		Street Address City State Zip	Street Address City State Zip