Position
---Accounts PayableOffice AssistantCommercial A/C ServiceResidential A/C ServiceProject ManagerOther

Today's Date:

Your Name:

Social Security #:

Home Phone #:

Work Phone #:

Email:

Current Address:

City:

State:

Zip:

Prior Address:

City:

State:

Zip:

Start Date:

Job Category:
Full-TimePart-TimeTemporaryLabor Pool

Availablity
WeekdaysWeekendsEveningsNightsOvertimeShiftOther

Valid Driver's License
Yes

Name on License

License #:

License Type:

State:

Moving Violation in the last 7 years?
Yes

Violations

Have you been given a job description?
Yes

Do you understand essential functions?
Yes

Can you perform these functions?
Yes

Have you used any other names or Social Security #'s?
Yes

Have you been convicted of a crime in the last 7 years?
Yes

Incident #1:

City/State:

Charge:

Incident #2:

City/State:

Charge:

States & Countries you have lived in:

Comments:

Most Recent Employer:

City/State:

Phone:

Fax:

Employment Dates

Your Title

Supervisor Name:

Reason For Leaving

Salary

Job Duties:

Previous Employer #1:

City/State:

Phone:

Fax:

Employment Dates

Your Title

Supervisor Name:

Reason For Leaving

Salary

Job Duties:

Previous Employer #2:

City/State:

Phone:

Fax:

Employment Dates

Your Title

Supervisor Name:

Reason For Leaving

Salary

Job Duties:

Include only individuals familiar with your work ability.
Do not include relatives or names of supervisors listed above.

Reference #1 Name

Address

Years Known

Highest Grade Completed

High School Name

City/State

Graduated?

Obtained Degree?

College Name

City/State

Graduated?

Obtained Degree?

Other School Name

City/State

Graduated?

Obtained Degree?

How did you hear about us?

---RadioAdNewspaper/PrintMonsterIndeedCraigslistPersonal ReferenceCareer CenterOther

Disclosure to Employment Applicant

Drug-free Workplace

Certified AC Services is dedicated to the health and safety of its employees and anyone person who comes in contact with our workplace or uses our services. Given the adverse effects of substance abuse, Certified AC Services is committed to a Drug-Free Workplace. Any violation of this policy will result in adverse action including but not limited to dismissal and prosecution.

Regarding Procurement of A Consumer Report

The information provided in this Application for Employment is true, correct and complete. If employed, and misstatement or omission of fact on this application may result in 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. If hired, I acknowledge that my employment with Certified AC Services will be at-will. In other words, my employment may be terminated at any time, by either party, with or without cause and without notice. I understand and agree that if I will work over forty (40) hours in a workweek, I will be paid overtime compensation if required by federal law. Further, I agree that I will not be paid any extra pay if I work over eight (8) hours in a day.

By your signature below, you hereby authorize us to obtain a consumer report about you in order to consider you for employment.

Do you agree with the above statement? *

I Accept

Applicants Name

Address

City/State/Zip

Social Security #

Please type your name on the following
line as your DIGITAL SIGNATURE:

Date