This employer complies with the American with Disabilities Act of 1990. We will not use the information on this application to discriminate against any individual with respect to their compensation, terms, conditions, or privileges of employment because of race, color, religion, sex, age, national origin, marital status, sexual orientation or disabilities.

Position Desired

SSN#

First Name

Middle Name

Last Name

Street Address

City State Zip

Phone Number

E-mail Address

Have you, since the age of 18, ever been convicted of a misdemeanor or felony? (Note: A conviction will not necessarily bar you from employment) If so, please explain.

Employment History

Please list the last three positions you have held, beginning with the most recent. All information is required even if you are submitting a resume.

Start Date End Date Employer

Street Address

City State Zip

Supervisor

Title

Phone Number

Reason For Leaving

Explain if we should not contact

Start Date End Date Employer

Street Address

City State Zip

Supervisor

Title

Phone Number

Reason For Leaving

Explain if we should not contact

Start Date End Date Employer

Street Address

City State Zip

Supervisor

Title

Phone Number

Reason For Leaving

Explain if we should not contact

Education

High School Course of Study Degree Earned

College Course of Study Degree Earned

Techincal School Course of Study Degree Earned

Other Course of Study Degree Earned

Professional References

List names and telephone number of three business /work references

Name Relationship Phone Number

Name Relationship Phone Number

Name Relationship Phone Number

Certification & Agreement

By submitting the following form you agree to all of the following:

I certify that the answers given herein are true and complete. I authorize investigation of statements contained herein as may be necessary. I understand that false statements, omissions, or misleading statements on this application shall be considered cause for dismissal. If my employment is terminated because of such omissions or misleading statements, I agree that my employers shall not be held liable in any respect.

Background Investigation Authorization and Release of Liability
I hereby authorize the release to Central Florida Electric of Ocala, Inc. any information held by parties regarding my prior employment, criminal, credit, driving, workers, compensation and educational history as well as information regording my general character and reputation. I release any providers of such information from any liability for providing the same. I understand that my employment with Central Florida Electric of Ocala, Inc may depend upon the successful completion of a criminal background investigation. I further acknowlendge that Central Florida Electric of Ocala, Inc. is relying on third party information and I therefore release CFE, and their respective owners, officers, agents and employees from any and all liability arising out of errors or omissions.