Employment Form

Powell Engineering, Inc.
Preliminary Employement Application

Are you Currently Employed*
YES
NO
Where are you currently or last employed?*
Position*
Employment Dates*
List Mechanical Skills and/or Experience*
Do you have a High School Diploma?*
YES
NO
Do you have a GED HS diploma equivalent?*
YES
NO
Do you have a valid drivers license?*
YES
NO
Do you have reliable transportation?*
YES
NO
Have you ever been convicted of a DUI or DWI?*
YES
NO
Have you had more than 1 moving violation, accident, or speeding ticket in the last 3 years?*
YES
NO
If yes please specify

Are you able to work a 40 hour work week every week?*
Yes No

Do you have references upon request?* Yes No

Comments or Additional Information

Phone, FAX, or mail to :

Powell Engineering, Inc.

P. O. Box 818

Pinson, AL 35126

Phone: (205) 681-8325

Toll Free: (800) 213-4267

FAX: (205) 681-8302