Application for Employment - Conditioned Air

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Technical Staff Application for Employment

Affirmative Action / Equal Opportunity Employer
M/F/D/V
DRUG FREE WORKPLACE

Conditioned Air Corp. - is committed to a policy of issuing each applicant equal employment opportunity and non-discrimination without regard to an individuals race, color, religion, creed, gender, national origin, ancestry, disability, marital status, age, or any other classification which is, or may in the future, become protected under applicable laws in all matters involving the terms and conditions of one's employment. No question on this application is intended to secure information to be used for discriminatory purposes.

The employment relationship at Conditioned Air Corp. is at will, which means that employment can be terminated at any time, and for any reason, at the option of either Conditioned Air Corp. or the employee. Questions about these policies may be addressed to a Human Resources Employment Representative of Conditioned Air Corp.

Please answer all questions below completely and accurately. Incomplete applications may be rejected.

PERSONAL INFORMATION

* required field

* Name (Last, First, Middle):

* Social Security #:

For purposes of verifying education and past employment please indicate any other name(s) you may have used
(First, Middle, Last):

Day Phone Number:

Evening Phone Number:

Email:

Present Street Address:

City:

State:

Zip Code:

Years at This Address

If you have lived at the above address for less than six (6) months, list your previous address:

Previous Street Address:

City:

State:

Zip Code:

Years at This Address

Employment related information / documentation:

If hired, will you be able to furnish proof of eligibility to work in the US?

Yes

If under the age of 18, please state your age:

If selected for employment, will you be able to submit a work permit?

Yes

If you are applying for a position involving driving, do you have a valid driver's license?

Yes

If yes, please list any traffic offenses or citations received in the last 36 months.

Driver's License #:

State of Issuance:

Have you ever been convicted of a criminal offense (whether a felony or misdemeanor) other than a minor traffic violation?

Yes

If yes, indicate the date(s) of conviction and the type(s) of offense(s):

(NOTE: A conviction does not automatically disqualify an applicant from employment. The date, nature and seriousness of the offense, as well as any rehabilitation will be considered.)

EMPLOYMENT HISTORY

Please list a employment beginning with your present or most recent employee. Include all periods of self-employment or unemployment, service work, summer and part time jobs.

May we contact your present employer?

Yes

Employer (present or most recent):

Employer (Name of Business)

Type of Business

Employer Street Address:

City:

State:

Zip Code:

Employer Phone Number:

Dates Employed:

From:

To:

Salary:

Beginning:

Ending:

Bonus or Commission:

Type of Position:

Full Time

Part Time

Internship

Description of Work:

Reason for Leaving:

Were you involuntarily terminated from this position?

Yes

Another Previous Employer

Employer (Name of Business)

Type of Business

Employer Street Address:

City:

State:

Zip Code:

Employer Phone Number:

Dates Employed:

From:

To:

Salary:

Beginning:

Ending:

Bonus or Commission:

Type of Position:

Full Time

Part Time

Internship

Description of Work:

Reason for Leaving:

Were you involuntarily terminated from this position?

Yes

Another Previous Employer

Employer (Name of Business)

Type of Business

Employer Street Address:

City:

State:

Zip Code:

Employer Phone Number:

Dates Employed:

From:

To:

Salary:

Beginning:

Ending:

Bonus or Commission:

Type of Position:

Full Time

Part Time

Internship

Description of Work:

Reason for Leaving:

Were you involuntarily terminated from this position?

Yes

OTHER QUESTIONS:

Are you subject to any restrictions in the scope of your contemplated employment activities as a result of your current or prior employment, such as agreements to protect confidential or proprietary information, or agreements not to compete or solicit former customers?

Yes

If yes, explain:

Have you served in the Armed Forces of the U.S.?

Yes

JOB REQUIREMENTS

Position you are applying for:

Would you prefer:

Full Time

Part Time

Internship

Occasional Worker/ Temporary

Indicate times you are available to work:

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

If necessary, would you be willing to work additional hours?

Yes

Date available to begin employment:

Salary Expectations
(Please be specific):

How did you hear about us?

EDUCATION

High School

High School Name

Street Address:

City:

State:

Zip Code:

Did you graduate?

Yes

If no, highest grade completed or G.E.D.:

Courses of Study

College

College Name

Street Address:

City:

State:

Zip Code:

Degree Earned:

Dates in College:

From:

To:

Courses of Study

Other

Institution Name

Street Address:

City:

State:

Zip Code:

Degree Earned:

Dates:

From:

To:

Courses of Study

List any courses you have taken or additional experience that you may have that would be applicable or beneficial to the position for which you are applying:

REFERENCES

List persons, not related to you, whom you have known at least one year.

	Name	Address	Business	Years Known
1.
2.
3.

CONDITIONS OF EMPLOYMENT

Please read the following Conditions of Employment carefully before signing. If you have any questions regarding these statements, please discuss; them with a Human Resources Employmenf Representative. Please read the following items carefully and check the boxes next to each one:

*		1) I hereby authorize Conditioned Air Corp., its employees, agents and independent contractors to conduct an investigation into my background for the purpose of evaluating my qualifications for employment. I agree that Conditioned Air Corp., its employees, agents and independent contractors may request information from former employers, educational institution(s), business and professional organizations, credit bureaus, local, state and federal law enforcement agencies, individuals with whom I have been associated, and with any others who may - have information regarding my competence, character of qualifications, and any and all other sources considered appropriate by Conditioned Air Corp.

*		2) I hereby release Conditioned Air Corp., its employees, agents and independent contractors from any liability for their action in investigating, considering, and evaluating my competency, character and qualifications, and I further release from any liability all Individuals and organizations who provide information concerning my competence, character, qualifications and other applicable background information for employment with Conditioned Air Corp.

*		3) I understand that nothing in this application is intended to create a promise of employment for any period of time or any contractual duty to me. I further understand that any misrepresentation, falsification of withholding of information regarding my employment history, academic attainments, qualifications, or other background information may disqualify me from further consideration as a candidate for employment with Conditioned Air Corp.

*		4) As part of Conditioned Air Corp.'s effort to provide a safe and healthy work environment for employees, Conditioned Air Corp. may test employment applicants for the presence of controlled substances. I understand that Conditioned Air Corp. may require me to undergo a test for these substances by an agent selected by Conditioned Air Corp. as a condition of my employment or continued employment, I further understand that my drug test must be negative to be considered for employment with Conditioned Air Corp.

*		5) I affirm that any statements and information contained herein are true. I have not knowingly falsified or withheld any facts or circumstances that, if disclosed, would adversely affect my application for, or employment with, Conditioned Air Corp.. I understand that any such falsification or withholding, no matter when it is discovered, is grounds for my application to be rejected or my immediate termination if I am employed.

I have read, understand, and agree to the conditions of employment listed above. In the event of my employment, I understand that I will receive a copy of the conditions of my employment and will pledge to preserve in confidence any information concerning the business of Conditioned Air Corp. and its customers which comes to my knowledge through my position. I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Conditioned Air Corp. and me either for employment or the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise is binding upon Conditioned Air Corp. unless made in writing by an officer or designated Human Resources Representative of Conditioned Air Corp.. If employment relationship is established, I understand that I am an employee at will which means that I have the right to terminate my employment at any time, and the Conditioned Air Corp. has the same right to terminate my employment at any time.

Applicant Signature :
(type your full name)

Date:

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