Kentucky
(859) 255-9546
2421 Fortune Dr., Suite 150
Lexington, KY 40509

Kentucky
(502) 261-8455
11441 Blankenbaker Acs Dr.
Louisville, KY 40299-6418

Tennessee
(731) 286-2772
1106 East Court St.
Dyersburg, TN 38024

Application

Please fill out the following employment application to be considered for employment at Amteck. You may want to print this page for your records once it is complete and before you press the “Submit Application” button at the bottom of this page. Amteck is an Equal Opportunity Employer.

GENERAL INFORMATION
First Name:
Middle Initial:
Last Name:
Email:
SSN:
Street Address:
City:
State:
ZIP:
Home Phone:
Other Phone:
Position you are applying for:
Have you Ever Applied for Employment
or Been Previously Employed By this Company?
Referred By:
Have you Been Convicted of a Felony
Within the Last 7 Years?
Wage Expected: $
Are you Legally Eligible for Employment
in the United States?
Your Age (If Under 18 Years Old):
Date Available for Work
Are you Willing to Travel if the Job Requires It?
HIRING AS A TRAVELING EMPLOYEE
Are you Willing to Accept Wages in Lieu of Benefits if Hired as a Traveling Employee?
Would you Be Willing to Waive Insurance Benefits for Wages if Hired as a Traveling Employee?
REFERENCES
Name Address/Phone Occupation Years
Known
EDUCATION
Name and location of school Course of
study
Years
completed
Did you graduate? Degree/
Diploma
High School
College
Vocational/Trade or apprentice courses
JOB RELATED SKILLS AND REQUIREMENTS
Do you Have a Valid Drivers License?
Drivers License Number:
Type of Drivers License:
State:
Do you Hold a Journeyman Electrician License or Any Other Electrician License With Any State, County or Municipality?
If Yes, Please List the License Number(s), Dates(s) of License(s) and Location of Issue:
License 1:

License 2:

License 3:

Do you Understand that Mandatory Drug Testing is Required?
Have you Been Given a Job Description or Had the Essential Functions of the Job Explained to you?
Do you Understand the Essential Job Functions?
Can you Perform the Requirements of This Job With or Without Reasonable Accommodation?
Have you Had Safety Training for Electrical Work?
If yes, Please Describe:
EMPLOYMENT HISTORY:CURRENT EMPLOYER
Company Name:
City/State:
Phone:
Dates Employed: From To
Job Title:
Supervisor's Name:
Duties:
Salary: $
Benefits Received:
Reason for Leaving:
Currently Working for This Employer?
If Yes, May we Contact Them?
SECOND MOST RECENT EMPLOYER
Company Name:
City/State:
Phone:
Dates Employed: From To
Job Title:
Supervisor's Name:
Duties:
Salary: $
Benefits Received:
Reason for Leaving:
THIRD MOST RECENT EMPLOYER
Company Name:
City/State:
Phone:
Dates Employed: From To
Job Title:
Supervisor's Name:
Duties:
Salary: $
Benefits Received:
Reason for Leaving:
Any other comments you would like to have considered as part of this application may be listed below:
*Special Employment Notice to Disabled Veterans,
Vietnam Era Veterans, and Individuals with Physical or Mental Handicaps*

Government contractors are subject to Section 402 of the Vietnam Era Veterans Readjustment Act of 1974, which requires they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals. Additionally, this Company complies with the Americans with Disabilities Act, and is willing to make reasonable accommodations to aid the employment of handicapped or disabled applicants.

Although you are not required to disclose information about physical or mental limitations that you believe will not interfere with your capability to do the job, if you want this Company to consider special arrangement to accommodate a physical or mental impairment, you may identify that impairment in the space provided below and suggest the kind of accommodation that you believe would be appropriate.

If you are a disabled veteran, or have a physical handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodations to enable you to perform the job in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect any consideration you may receive for employment.

If you wish to be identified, please indicate below:

This Company does not require a pre-employment medical examination, but does reserve the right to require a medical examination after an offer of employment is made to an applicant. All offers of employment are conditioned upon the passing of a drug test for the purpose of detecting the use of drugs. Also, if an employment offer is made you may be asked to complete a medical questionnaire. Medical examinations and answers to medical inquiries will be maintained on separate forms, and will be treated as confidential medical records. An applicant will not be excluded from employment unless they have medical conditions that prohibit their ability to perform the essential job functions of the position he or she desires with this Company. The Company will make reasonable accommodations to aid handicapped applicants or employees in fulfillment of essential job functions. Written job descriptions are available and will be furnished to applicant upon request.

This Company does require that all applicants are pre-tested for their electrical knowledge and experience prior to considerations for employment. The testing will be conducted by Amteck of Kentucky, located at 2421 Fortune Drive, Suite 150, P. O. Box 55194, Lexington, Kentucky, or by approved individuals or organizations.

I hereby declare that all information provided in the above application is complete and accurate tothe best of my knowledge, and I have read and understand the terms and conditions for employment with Amteck. I also understand that providing false or misleading information on this application may constitute grounds for termination.
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