Cornerstone Electrical Contractors, LLC

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If selected for employment are you willing to submit a pre-employment drug screening?

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Education

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Dates employed

Employer

Work Phone

City

Address

State

Pay Rate

Position

Duties

Reason for leaving

Supervisor's Name

May we contact them?

Yes
No

Dates employed

Employer

Work Phone

City

Address

State

Pay Rate

Position

Duties

Reason for leaving

Supervisor's Name

May we contact them?

Yes
No

References

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Phone

Title

Name

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Title

Name

Phone

Title

YES I certify that all answers given are true and complete to the best of my knowledge
YES I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
YES In the event of employment, I understand that false of misleading information given in my application or interview(s) may result in discharge.

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