Application for Employment We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.Position Applied For*HVAC TechnicianHVAC Installation Technician HelpersHVAC Maintenance technicianCustomer Service RepresentativeWage DesiredDate of Application MM slash DD slash YYYY HOW DID YOU LEARN ABOUT US?* Advertisement Relative Inquiry Employment Agency Friend Other ARE YOU WILLING TO PERFORM A DRUG TEST?* Yes No If No, Why?Personal InformationName* First Middle Last Address* Number Street City State Zip Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone Phone(s)*Social Security NumberDate Available to Start* MM slash DD slash YYYY Best time to contact you* : Hours Minutes AM PM AM/PM Do you have an email address you are willing to provide? Yes No If yes, please provide it* Have you ever filed an application with us before?* Yes No If yes, give date: MM slash DD slash YYYY Have you ever been employed with us before?* Yes No If yes, give date:* MM slash DD slash YYYY Do any of your friends or relatives, other than spouse, work here?* Yes No If yes, please list:*Are you currently employed? Yes No May we contact your current employer?* Yes No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment)* Yes No Do you have any condition(s) which may affect your ability to perform the essential job functions of the position for which you are applying for?* Yes No If yes, please explain:*Do you have a valid Driver’s License?* Yes No Do you have reliable transportation? Yes No Are you currently on “Lay-Off” status and subject to recall?* Yes No Education DetailsElementary SchoolName and Address Of SchoolCourse of StudyYears CompletedDiploma DegreeHigh SchoolName and Address Of SchoolCourse of StudyYears CompletedDiploma DegreeVocational SchoolName and Address Of SchoolCourse of StudyYears CompletedDiploma DegreeUndergraduate CollegeName and Address Of SchoolCourse of StudyYears CompletedDiploma DegreeOther (Specify)Name and Address Of SchoolCourse of StudyYears CompletedDiploma DegreeDescribe any specialized training, apprenticeship, skills and extra-curricular activitiesPlease Answer the Following Questions:1. Have you ever pleaded Guilt or No Contest to, or been convicted of any criminal offense, other that the applicable exceptions listed below? Yes No * Do not include misdemeanor marijuana-related convictions that are more than (2) years old misdemeanor convictions for which probation was successfully completed or otherwise discharged and the case was judicially dismissed * Do not include convictions that were sealed, eradicated, erased, annulled by a court, or expunged, or convictions that resulted in referral to a diversion program.2. Have you ever been arrested for any matters for which you are out on bail or on your own recognizance pending trial? Yes No Criminal Offenses Only: If you answered YES, to either of the above two questions, please provide the date(s) and explain in accordance with the above instructions so that individual circumstances can be considered.Criminal convictions will not automatically disqualify an applicant from a particular job. The Company will consider the nature of the crime, its seriousness, where the conviction substantially relates to the position functions and qualifications, the frequency of convictions, the applicant’s age at the time of the conviction, the time elapsed since the date of conviction or completion of jail sentence, the applicant’s entire work and educational history, and employment references and recommendations2. Have you ever initiated an act of violence in the workplace?* Yes No If YES, please provide the date(s) and explain so that individual circumstances van be considered. (A “Yes” answer will not necessarily disqualify you from employment)Employment ExperienceStart with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. Provide up to 10 Years Work HistoryEmployer 1Name of Employer 1Address of Employer 1Telephone Number(s)Date Employed From (mm/dd/yyyy) MM slash DD slash YYYY Date Employed To (mm/dd/yyyy) MM slash DD slash YYYY NumberNumberJob TitleSupervisorWork PerformedEmployer 2Name of Employer 2Address of Employer 2Telephone Number(s)Date MM slash DD slash YYYY Date MM slash DD slash YYYY NumberNumberJob TitleSupervisorWork PerformedEmployer 3Name of Employer 3Address of Employer 3Telephone Number(s)Date MM slash DD slash YYYY Date MM slash DD slash YYYY NumberNumberJob TitleSupervisorWork PerformedEmployer 4Name of Employer 4Address of Employer 4Telephone Number(s)Date Employed From (mm/dd/yyyy)Date Employed To (mm/dd/yyyy)NumberNumberJob TitleSupervisorWork PerformedList professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.Additional InformationOther QualificationsSummarize special job-related skills and qualifications acquired from employment or other experience.If the position(s) you are applying for requires a license (including driver’s license), certification, or other authorization to practice a trade or profession, complete the following section.1 Type and/or ClassLicense NumberExpiration DateGranted By (Board or Commision)State2 Type and/or ClassLicense NumberExpiration DateGranted By (Board or Commision)State3 Type and/or ClassLicense NumberExpiration DateGranted By (Board or Commision)StateState any information that you feel may be helpful to us in considering your application.REFERENCES:Give the names of three persons not related to you, whom you have known at least one year.1 NameAddressPhone Number2 NameAddressPhone Number3 NameAddressPhone NumberApplicant's StatementI certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 180 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.SignatureDate MM slash DD slash YYYY Δ
