Clifford Power Systems, INC.

   Application for Employment

Last Name First Middle Date of Application
Present Address - Street City State Zip
Permanent Address - Street City State Zip
Phone Number      
     
Position Desired
Full Time Part Time
Shift Work Temporary
Date you can start Salary Desired Are you employed now? May we contact your employer?
Have you ever applied here before? Yes No If yes, give date:
 In case of emergency nofity:
  Name Address Phone
 
Are you 18 years of age or older?   Are you a United States citizen or do you have authorization to work in the United States?
Yes No   Yes No
What languages, other than english do you speak, read and/or write?
Speak Write Read Degree of Fluency:
Speak Write Read Degree of Fluency:
Have you ever pled guilty, pled nolo contendere or been found guilty of a crime (list all felonies and misdemeanors, including DUI's, DWI's and drug crimes, but exclude minor traffic tickets such as speeding)?*
Yes No If yes, please describe:
* A "Yes" answer will not automatically disqualify an applicant from being considered as a candiditate for employment; the nature and date of the crime and relation to specific job requirements will be considered.
Have you ever been fired from any job for any reason, or did you quit before or after being told you would be fired?
Yes No If yes, please describe:
Education
  Name & Location Major Course Subject Last Year Completed Graduted or GED Degrees
High School
Technical School
College
Graduate School
Employment Experience (Start with your present or last job.)
Date Employed   Salary
From To Name and Address of Employer Starting Ending Position Reason for Leaving
References
  Name Address Phone No. Business Yrs. Acquainted
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