Application Form Applicants may be test for illegal drugs Name Present address How long have you lived at your present address Telephone Social Security No. If under 18, please list age Position applied for Salary desired (Be specific) Days/hours available to work Mon Tue Wed Thu Fri Sat Sun How many hours can you work weekly? Can you work nights? YesNo Employement Desired Full-Time OnlyPart-Time OnlyFull or Part Time Schooling Highschool Name of school Location (Complete mailing address) Numbers of years completed Major & Degree College Name of school Location (Complete mailing address) Numbers of years completed Major & Degree Bus. or Trade School Name of school Location (Complete mailing address) Numbers of years completed Major & Degree Professional School Name of school Location (Complete mailing address) Numbers of years completed Major & Degree Have you ever been convicted of a crime? NoYes If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. Do you have a Driver's License? YesNo What is your means of transportation to work? Drivers license number State of Issue Expiration Date OperatorCommercial (CDL)Chauffeur Have you have any accidents during the part three years? (Explain) Have you had any moving violations during the past three years? (Explain) Please list two references other than relatives or previous employers. Reference 1 Name Position Company Address Telephone Reference 2 Name Position Company Address Telephone An application form sometimes make it difficult for and individual adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which are applying. Military Have you ever been in the armed forces? YesNo Are you now a member of the national guard? YesNo Specialty Date Entered Work Experience Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name Current employer Name of Employer Address City, State, Zipcode Phone number Name of last supervisor Employement dates (From, To) Pay or salary Your last job title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements of promotions while you worked at this company Next employer (leave blank if not applicable) Name of Employer Address City, State, Zipcode Phone number Name of last supervisor Employement dates (From, To) Pay or salary Your last job title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements of promotions while you worked at this company Next employer (leave blank if not applicable) Name of Employer Address City, State, Zipcode Phone number Name of last supervisor Employement dates (From, To) Pay or salary Your last job title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements of promotions while you worked at this company Next employer (leave blank if not applicable) Name of Employer Address City, State, Zipcode Phone number Name of last supervisor Employement dates (From, To) Pay or salary Your last job title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements of promotions while you worked at this company Next employer (leave blank if not applicable) Name of Employer Address City, State, Zipcode Phone number Name of last supervisor Employement dates (From, To) Pay or salary Your last job title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements of promotions while you worked at this company Next employer (leave blank if not applicable) Name of Employer Address City, State, Zipcode Phone number Name of last supervisor Employement dates (From, To) Pay or salary Your last job title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements of promotions while you worked at this company Next employer (leave blank if not applicable) Name of Employer Address City, State, Zipcode Phone number Name of last supervisor Employement dates (From, To) Pay or salary Your last job title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements of promotions while you worked at this company Next employer (leave blank if not applicable) Name of Employer Address City, State, Zipcode Phone number Name of last supervisor Employement dates (From, To) Pay or salary Your last job title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements of promotions while you worked at this company Next employer (leave blank if not applicable) Name of Employer Address City, State, Zipcode Phone number Name of last supervisor Employement dates (From, To) Pay or salary Your last job title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements of promotions while you worked at this company Next employer (leave blank if not applicable) Name of Employer Address City, State, Zipcode Phone number Name of last supervisor Employement dates (From, To) Pay or salary Your last job title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements of promotions while you worked at this company May we contact your present employer? YesNo Did you complete this application yourself? YesNo If not, who did? APPLICATION FORM WAIVER In exchange for the consideration of my job application by Keefe’s Air Conditioning & Heating(hereinafter called “the Company”), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Keefe’s Air Conditioning & Heating, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and of Keefe’s Air Conditioning & Heating may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract. I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of jobrelated physical examinations. I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. I further understand that my employment with the Company shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party. Signature of applicant (By writing your name you are agreeing to sign this) Date This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications. Thank you for completing this application form and for your interest in our business.
