Electrical Lineworker Program Application Electrical Lineworker Program Application Date(Required) MM slash DD slash YYYY Name(Required) First Middle Last Last Four of Social Security Number(Required) Phone Number(Required)Full Mailing Address(Required) Address, State, ZipEmail(Required) Date of Birth(Required) Age(Required) Height(Required) Weight(Required) Shirt Size(Required) Emergency Contact Person Phone Number(Required) Relation to personCan you, read, write and speak English?(Required) Yes No Are you over the age of 21?(Required) Yes No If you answered NO, to the question above, please state your age below.Can you provide proof of Medical Insurance for the duration of the course?(Required) Yes No Can you provide a Highschool Diploma or the equivalent(Required) Yes No Are you a United States Citizen(Required) Yes No Do you have a valid California Drivers License(Required) Yes No What will be your source of funding? Please state your answer below.(Required)How did you hear about us? Please state your answer below.(Required)Is there any reason you could not move to relocate for a job if one is offered to you?(Required) Yes No Has your drivers' license ever been suspended or revoked?(Required) Yes No Have you ever had a DWI or DUI?(Required) Yes No If you answered YES, to the question above state the MONTH & YEAR(Required)Have you had any accidents in the past 3 (three) years?(Required) Yes No Have you ever been arrested for any narcotic charges?(Required) Yes No Do you have any felonies or misdemeanors?(Required) Yes No Have you ever held a commercial license?(Required) Yes No Do you have any physical or mental disabilities at this time?(Required) Yes No Are you currently on any medications?(Required) Yes No Do you wear any hearing apparatus?(Required) Yes No Do you have any eyesight impairments or colorblindness?(Required) Yes No Have you physically lost any part of your body?(Required) Yes No Are you presently employed?(Required) Yes No Is there a reason you cannot verify your past employment history for 10 years?(Required) Yes No Have you ever been on Probation or Parole?(Required) Yes No Have you ever been fired from a past employer?(Required) Yes No Have you ever been injured on the job or received workers comp.?(Required) Yes No Are you married?(Required) Yes No Do you have any children?(Required) Yes No Last four of Social Posted in Uncategorized
Monday–Friday: 8:00AM-5:00 PM
Monday–Friday: 8:00AM-5:00 PM
