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Apply for a Job
EMPLOYMENT APPLICATION
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PERSONAL INFORMATION
Full Name
*
Present Address
Date of Birth (If under 18)
Phone Number
Social Security Number
Email Address
*
Resume Upload
Click or drag a file to this area to upload.
Are you legally authorized to work in the United States?
YES
NO
POSITION OBJECTIVE
Position applied for
Type of employment
Part Time
Full Time
Temporary
Desired Salary
Date Available
Which Location Are You Applying To?
Have you ever been employed by Dominion before or have any family members worked at Dominion now or previously?:
YES
NO
If YES, who?
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Where you referred to us?
YES
NO
If yes, by whom?
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EDUCATION
SCHOOLS
High School:
College:
Trade School:
NAME
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DEGREE/DIPLOMA EARNED
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YEARS ATTENDED
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MILITARY SERVICE
Veteran?
YES
NO
Rank Achieved
Branch of Service
AUTOMOBILE USE
Do you have a valid driver’s license?
YES
NO
Driver’s License Number
State
Class/Type
Exp Date
Do you have active automobile insurance?
YES
NO
Name of Carrier & Policy Number
Have you had your driver’s license provoked in the past 3 years?
YES
NO
If YES, why?
Single Line Text
EMPLOYMENT HISTORY
Begin with your last position or present position if you are now employed. If you wish, you may exclude organizations which would indicate any status protected by federal, state, or local law.
Company Name
Address
Job Title
Immediate Supervisor
Phone Number
May we contact this employer?
YES
NO
Duties
Month/Year - From/To
Reason for leaving
Company Name
Address
Job Title
Immediate Supervisor
Phone Number
May we contact this employer?
YES
NO
Duties
Month/Year - From/To
Reason for leaving
AUTHORIZATION DATA
Dominion Electric Supply is very interested in its people and the work environment. We are committed to the belief that through your professional growth we can achieve our goals as a company. For this reason we require the following authorizations in order to properly evaluate your qualifications. We urge you th read the following points carefully before signing this employment application. I understand and agree to the following: A) The company and my previous employer(s) shall not be held liable in any respect if employment is not tendered, is withdrawn, or my employment is terminated due to falsification of my statements and answers in this application form. If I am employed, additional personal data will be required for determination of benefits and statistical purposes. B) The Company complies with the federal Drug-Free Workplace Act of 1988 and expects all employees to work unimpaired by alcohol or drugs. If the Company makes me a conditional offer of employment, I may be required to undergo illegal drug and/or alcohol testing, depending on my position. Testing will be performed at the Company’s expense and in compliance with applicable law. I understand that Dominion reserves the right to rescind an offer of employment based on the results of a drug or alcohol test. C) If I am employed by the Company, the Company or I may terminate that employment at will at any time and for any reason or no reason at all . No employee of the Company has the authority to modify this orally or in writing, except with the written approval of the Chief Executive Officer, or the President of the Company. D) Though management tries to reasonably schedule employees based on their individual needs, business conditions may at times require working overtime, shift work, or a schedule that includes Saturdays, Sundays, and/or holidays. The Company will provide reasonable accommodation for employees’ sincerely held religious practices or any other accommodations required by state, federal or local law. E) If I am employed by the Company, I will fully adhere to all of the Company’s policies and rules of employment.
I hereby acknowledge that I have read the above statements and understand them, and that any misrepresentation or omission of the facts called for herein will at the Company’s option, result in the cancellation of consideration for employment, or dismissal from the Company if I have been employed.
Signature
Clear Signature
Date
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