Employment Application

Applicant Information

Last Name *

First Name *

Middle Initial *

Date *

Street Address *

Apartment/Unit #

City *

State *

Zip Code *

Phone *

Email *

Date Available *

Social Security No. *

Desired Salary *

Position Applied For *

Are you a citizen of the United States?*

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

Proof MUST be provided: Visa, Green Card, Social Security Card, and/or Driver's License.

Do you have a valid Driver's License? *

Yes

No

Driver's License Number

Have you ever worked for this company? *

Yes

No

If yes, when?

If under 18 years of age, can you provide proof of eligibility to work? *

Yes

No

Have you ever been convicted of a felony (other than a traffic violation)? *

Yes

No

If yes, please explain.

Have you ever been convicted of a DUI? *

Yes

No

Certifications

Please list all HVAC experience here.

Education

High School *

Address *

From *

To *

Did you graduate? *

Yes

No

Diploma

College/University

Address

From

To

Did you graduate?

Yes

No

Degree

Trade School / Other

Address

From

To

Did you graduate?

Yes

No

Degree

References

Please list three professional references.

Full Name *

Relationship *

Company *

Phone *

Address *

Full Name *

Relationship *

Company *

Phone *

Address *

Full Name *

Relationship *

Company *

Phone *

Address *

Previous Employment

Company

Phone

Address

Supervisor

Position / Job Title

Starting Salary

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for reference?

Yes

No

Company

Phone

Address

Supervisor

Position / Job Title

Starting Salary

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for reference?

Yes

No

Company

Phone

Address

Supervisor

Position / Job Title

Starting Salary

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for reference?

Yes

No

Do you have a relative or friend employed with W.G. Speeks? *

Yes

No

If so, the Name of the individual

Are you currently on "Layoff" status subject to recall? *

Yes

No

Are you physically UNABLE to perform the duties of the position for which you are applying? *

Yes

No

Military Service

Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain:

Disclaimer and Signature

I understand this company adheres to a substance abuse policy and I agree to comply with its provisions. I also consent to a urine drug test as a part of the employment process. I authorize W.G. Speeks, Inc. to designate the laboratory of choice and to release the results to any Medical Review Officer or Company Representative that it designates. I understand that if this drug test is confirmed positive or if I refuse to be tested, my application will not be complete and I will not be hired.

Initials *

I certify that the information provided in this application for employment is true, correct and complete. If employed, any misstatement or omission of fact on this application, may result in my dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

Initials *

I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability, the Employer and its Representative for seeking such information and all other persons, corporations, or organizations for furnishing such information.

Initials *

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature *

Date *

For Office Use Only

Interviewed by

Date of Interview

Position

Pay Rate

Starting Date

Remarks

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Employment ApplicationW.G. Speeks

W. G. Speeks Employment Application

Applicant Information

Education

References

Previous Employment

Military Service

Disclaimer and Signature

For Office Use Only

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Heating & Cooling

Service Area