Rocky Mtn Electric, LLC

22115 CR 52
Greeley, CO 80631
Phone:(970)395-0536
Fax:(970)395-0537

Application For Employment

All candidates are subject to drug testing, background checks and color blind testing.

Position applied for:
Salary required: When can you start:

Name and Contact Information
Name
Last First Middle
Address
Street City State Zip
Phone
Home Office Cell
Email Birthdate
Have you ever been convicted of a felony? Yes No
Do you have any tattoos? Yes No
Any body piercings? Yes No
Licenses: Please list all states for any licenses you hold.
LICENSE STATES TESTED RECIPROCAL
Apprentice Registration
Residential Wireman
Journeyman
Masters

Education and Trainging
Current Training and Certifications: Please list all training and certifications that are current.
First Aid Certified
CPR
MSHA Trained
HazMat Trained
HazCom Trained
Versed in confined spaces
Other
Other skills or abilities: Please describe your proficiency, skills or abilities that enhance your qualifications.
SPECIFIC SKILL OR ABILITY SPECIFIC TOOL(S)
EQUIPMENT/HARDWARE/SOFTWARE		 PROFICIENCY LEVEL
(ADVANCED/INTERMEDIATE/BEGINNER)
Do you have a high school diploma? Yes No
Do you have a GED certificate? Yes No
NAME/LOCATION OF
SCHOOL(S)		 DATES ATTENDED MAJOR/COURSES OF
STUDY		 # OF CREDITS
COMPLETED		 DEGREE EARNED

Employment History

Provide your employment history as completely as possible starting with your present or most recent employer. Applications must be filled out completely and clearly showing that minimum qualifications are met. Include all paid, non-paid, volunteer and military experience
MAY WE CONTACT YOUR CURRENT EMPLOYER? Yes No
POSITION/TITLE EMPLOYER(COMPANY OR ORGANIZATION)
Name, Title, & Phone # of Immediate Supervisor Address of Employer Type of Business
Dates of Employment (mm/dd/yyyy) List Salary Hours Per Week Employees supervised
From To $ per
Reason for Leaving
Describe your major duties and responsibilities below:
POSITION/TITLE EMPLOYER(COMPANY OR ORGANIZATION)
Name, Title, & Phone # of Immediate Supervisor Address of Employer Type of Business
Dates of Employment (mm/dd/yyyy) List Salary Hours Per Week Employees supervised
From To $ per
Reason for Leaving
Describe your major duties and responsibilities below:
POSITION/TITLE EMPLOYER(COMPANY OR ORGANIZATION)
Name, Title, & Phone # of Immediate Supervisor Address of Employer Type of Business
Dates of Employment (mm/dd/yyyy) List Salary Hours Per Week Employees supervised
From To $ per
Reason for Leaving
Describe your major duties and responsibilities below:
POSITION/TITLE EMPLOYER(COMPANY OR ORGANIZATION)
Name, Title, & Phone # of Immediate Supervisor Address of Employer Type of Business
Dates of Employment (mm/dd/yyyy) List Salary Hours Per Week Employees supervised
From To $ per
Reason for Leaving
Describe your major duties and responsibilities below:

Professional References

PLEASE LIST THREE PROFESSIONAL REFERENCES (OTHER THAN RELATIVES) WHO YOU HAVE WORKED WITH
NAME ADDRESS TITLE PHONE YEARS
ACQUAINTED

In consideration of Rocky Mtn Electric, LLC’s (RME) evaluation of my suitability for employment, I hereby authorize RME to perform all checks of my credentials allowed by law, including, but not limited to, discussions with supervisors, co-workers, friends, business associates, or other individuals that RME, in its sole discretion, believes may have relevant information regarding my suitability for employment. I further authorize RME to perform the following checks on my credentials: request of police and/or credit report, and such other checks as RME deems appropriate.

I agree not to assert any claims of causes of action of any kind against RME, its agents, its employees, or any individual contacted by RME, arising out of RME’s investigation. I further release and forever discharge RME, its agents, its employees, and the individuals and companies contracted by RME as part of its investigation, from any and all claims, demands, damages, actions, cause of action, or suits of any kind of nature whatsoever arising from RME’s investigation of my credentials. I acknowledge that RME has made no representation of any kind as to whether employment will be offered at the conclusion of its investigation.

I CERTIFY that all statements in this application are true and complete. I agree and understand that any misstatements or omissions of material facts herein will cause forfeiture on my part of all rights to employment with Rocky Mtn Electric, LLC. I understand that reference checks may be made regarding my past employment.