662-680-9097|info@conditioned-air.net Facebook APPLICATION FOR EMPLOYMENT PERSONAL INFORMATION FULL NAME PRESENT ADDRESS CITY STATE ZIP CODE PERMANENT ADDRESS CITY STATE ZIP CODE PHONE NUMBER SECONDARY PHONE NUMBER REFERRED BY EMPLOYMENT DESIRED POSITION DATE YOU CAN START SALARY DESIRED ARE YOU EMPLOYED NOW? YES NO IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER? YES NO ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.? YES NO EVER APPLIED TO THIS COMPANY BEFORE? YES NO WHERE WHEN EDUCATION HISTORY HIGH SCHOOL YEARS ATTENDED DID YOU GRADUATE? YES NO SUBJECTS STUDIED COLLEGE YEARS ATTENDED DID YOU GRADUATE? YES NO SUBJECTS STUDIED TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL YEARS ATTENDED DID YOU GRADUATE? YES NO SUBJECTS STUDIED GENERAL INFORMATION SUBJECT OF SPECIAL STUDY / RESEARCH WORK SPECIAL TRAINING SPECIAL SKILLS U.S. MILITARY OR NAVAL SERVICE RANK FORMER EMPLOYERS LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH THE LAST ONE FIRST FROM TO NAME & ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING FROM TO NAME & ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING FROM TO NAME & ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING FROM TO NAME & ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING REFERENCES GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR NAME ADDRESS BUSINESS YEARS KNOWN NAME ADDRESS BUSINESS YEARS KNOWN NAME ADDRESS BUSINESS YEARS KNOWN AUTHORIZATION "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws." I AGREE SUBMIT EMPLOYEE APPLICATION Copyright 2016 Conditioned Air, Inc | All Rights Reserved | Website by Waters Creative

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