Breaker Electric Inc. is an equal opportunity Employer.  We do
consider applicants for all positions without regard to race, color,
religion, creed, gender, national origin, age, disability, veteran
status, or any other legally protected status.

Applying for a position with the Company does not guarantee an
interview or a call back.  In the event we are not hiring at the time
your application is submitted it will be kept on file for future
reference.
Date of Application
Position(s) Applied For
How Did You Learn About Us?
Advertisement
Relative
Friend
 Inquiry
Employment Agency
Other
Last Name
 First Name
 Middle Name
Address,
City, State,
Zip Code
Social Security
Number (Voluntary)
If you are under 18 years
of age, can you provide
required proof of your
eligibility to work?
Best Time to Contact You
Telephone Number
Yes
Alternate Phone Number
No
Yes
 If yes, please give date
Have you ever filed an application with us before?
No
Do any of your friends or relatives (including spouse) work here?
Yes
 If yes, please list names of current employees
No
Are you currently Employed?
Yes
No
May we contact your present employer?
Yes
No
Are you prevented from lawfully becoming employed
in this country because of Visa or Immigration Status?
Yes
No
Date available for work
 What is your desired salary range?
Are you available to work:
Full Time
Part Time
Can you travel if a job requires it?
Yes
No
Please list any schooling/education
that you have/have taken, pertinent to
the position you are applying for.
Work History
Dates Employed
Employer:

Address:

Telephone Number:

Job Title:

Supervisor:

Reason for Leaving:
Start Date
 End Date
Hourly Rate/Salary
Starting Pay
 Final Pay
May we contact your supervisor?
Yes
No
Give a brief description of what duties were expected at this job:
---------------------------------------------------------------------------------------------------------------------
Dates Employed
Employer:

Address:

Telephone Number:

Job Title:

Supervisor:

Reason for Leaving:
Start Date
 End Date
Hourly Rate/Salary
Starting Pay
 Final Pay
May we contact your supervisor?
Yes
No
Give a brief description of what duties were expected at this job:
---------------------------------------------------------------------------------------------------------------------
Dates Employed
Employer:

Address:

Telephone Number:

Job Title:

Supervisor:

Reason for Leaving:
Start Date
 End Date
Hourly Rate/Salary
Starting Pay
 Final Pay
May we contact your supervisor?
Yes
No
Give a brief description of what duties were expected at this job:
---------------------------------------------------------------------------------------------------------------------
References
Please list 3 references that we may contact.  Do not include family members.
Relation
Name
 Phone Number
Include any additional comments, information or skills that you would like us to know.
Your contact e-mail
Employment Application