Job Application Form

Sean McCuctheon’s Air Conditioning and Heating, Inc. is a drug-free workplace.

To be employed you must:

1. Have a clean record and be able to clear all background checks.
2. Have valid driver’s license

Personal Information

First Name*

Last Name*

Middle Initial

Address*

City*

State*

Zip*

Your Contact Information

Home Phone*

Cell Phone*

Email Address*

Please Answer The Following:

Date Available:

Desired Salary:

Position Applied for:

Are you a citizen of the United States?

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

Have you ever worked for this company?

If so, when?

Have you ever been convicted of a felony?

If yes, explain:

Education

High School

Name

Address

Dates Attended

Did You graduate? Yes No

Degree / Diploma

College

Name

Address

Dates Attended

Did You graduate? Yes No

Degree / Diploma

Other

Name

Address

Dates Attended

Did You graduate? Yes No

Degree / Diploma

Please list three professional references.

Reference 1

Full Name:

Relationship:

Company:

Phone:

Address:

Reference 2

Full Name:

Relationship:

Company:

Phone:

Address:

Reference 3

Full Name:

Relationship:

Company:

Phone:

Address:

Previous Employment

Employer 1

Name of company

Address

Start Date

End Date

Starting Salary

Ending Salary

Position

Reason For Leaving

Employer 2

Name of company

Address

Start Date

End Date

Starting Salary

Ending Salary

Position

Reason For Leaving

Employer 3

Name of company

Address

Start Date

End Date

Starting Salary

Ending Salary

Position

Reason For Leaving

Military Service

Branch:

Start Date

End Date

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Disclaimer and Digital Signature

"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.

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 have read the disclaimer

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