Online Job Application for Employment
Gulf Atlantic Electrical Constructors, Inc
We DO NOT discriminate on the basis of race, color, religion, national origin, sex, age, or disability. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors and requirements. We are a Drug FreeCompany and ALL new employees will undergo a Drug Screening.
Name: First Middle Last
Street Address
City and State
Home Phone
Social Security Number
Are You Over 18 Years Old? Yes or No
Are You Legally Eligible To Work In US? Yes or No
Valid Drivers License? Yes or No
License Number, State Issued, Exp Date
Ever Convicted of Any Misdemeanor?
Ever Convicted of Any Felony?
If Yes List, Dates and Disposition of Each
Position Seeking
Starting Wage Required Per Hour
Date You Can Start
Seeking Full or Part Time
Currently Employed
May We Contact Current Employer? Yes or No
If Yes Current Employer and Point of Contact
High School Grad? Year Completed?
List Any Trade School or College?
Any Other Electrical Education?
Current or Last Employer, Position Held, Responsibilities, Salary
Reason For Leaving
Employer Before Current, Position Held,Responsibilities, Salary
Reason For Leaving
Prior Employer, Position Held,Responsibilities, Salary
Reason For Leaving
Other Comments
Do You now have, or have you ever had, any of the following? Please check all that apply.
Epliepsy (convulsions, seizures)
Diabetes
Cardiac (heart) disease
Meniscectomy (inflammation of cartilage of certain joints--e.g. Knee)
Amputation of foot, leg, arm or hand
Total loss of sight of one or both eyes, or a partial loss of corrected vision of more than 75% bilaterally
Polio (Poliomyelitis)
Cerebral palsy
Multiple scerosis
Parkinson's disease
Patellectomy (surgically removed kneecap)
Ruptured cruciate ligament (knee ligament)
Hemophilia
Chronnic osteomyelitis (infection in bone)
Surgical or spontaneous fusion of a major weight-bearing joint (frozen joint)
Hyperinsulinism
Muscular dystrophy
Thrombophlebitis
Herniated intervertebral disk
Surgical removal of an intervertebral disk, or spinal fusion
Total Deafness
One or more back or neck injuries or a disease process of the back or neck, substantiated by a doctor's opinion and resulting in disability over a total of 120 or more days
Obesity (30% overweight)
Please list Any others known medical conditions not listed above
Have you previously received workers' compensation for an on-the-job injury? If Yes please list why, when and where
Have you ever received a disability rating or had one assigned to you by an insurance company or state/federal agency? If yes please state percentage and by whom
Have you ever injured, sprained or had surgery on your back? If yes please list details
Have you ever injured, sprained or had surgery on your neck? If yes please list details
Have you ever injured, sprained or had surgery on your knee? If yes please list details
Have you ever had any other type of surgery not mentioned above? If yes please list details
Do you have arthritis? If yes what parts of the body and do you take any medication for arthritis?
Do you take any medications not meantioned above? If yes please list ALL
The information on this form shall not be used to discriminate against a qualified individual with a disability because of the existence of the disability in regard to the following: job application procedures; hiring, advancement or discharge of the employee; employee compensation; job training; and other terms, conditions and privileges of employment. Under penalty of perjury, I declare that by sending the above information that I have read the foregoing and that the facts alleged are true to the best of my knowledge and belief.
Please note that by clicking on the "Send Application" button below you agree that ALL Information you have submitted is correct and can be verified by the information that you have supplied. Any False information provided may be grounds to refuse this application.

Our Address

Gulf Atlantic Electrical Constructors, Inc.
416 S. Hwy 393
Santa Rosa Beach, FL 32459

Contact us at (850) 622-2225  or  info@gulfatlanticelectric.com
Copyright © 2010 &Gulf Atlantic Electrical Constructors, Inc.