An Equal Opportunity Employer
EMPLOYMENT APPLICATION
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Last Name: First Name: Middle Initial:
_____________________________________________________________________________-
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Social Security Number
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Street Address City State Zip
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Telephone Number
( ) -
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If you become employed by Western can you provide proof of your right to remain and work in the United States?
_____Yes _____No
If you are under 18 please state your age. ____________
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What position are you applying for? What other positions would you consider?
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Date Available: Salary Desired: Referred to Western by:
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Please list friend and/or relatives currently working for other heating & cooling company: ________________________________________________________________________________________________________
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Have you ever been convicted of a crime other than a minor traffic violation? (A conviction record will not necessarily Bar employment).
______Yes ______No If yes, please list crime and date of conviction.
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Are there any restrictions on hours available for work? __________yes _________No if yes, please state.
(The Company will make reasonable efforts to accommodate religious beliefs.)
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In case of emergency notify: Telephone Number ( ) -
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NAME OF SCHOOL
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LOCATION
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LAST GRADE COMPLETED
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MAJOR
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DEGREE/DIPLOMA
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High School
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College
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Graduate School
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Trade, Business, or correspondence School
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List any special skills:
_________________________________________________________________________________________________________
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Employment Record – List your last three employers, starting with the last or current employer first. Attach an additional sheet if required.
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Name of Previous Employer
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Company Phone
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Your Position_____________________________
List your Duties and responsibilities:
________________________________________
________________________________________
________________________________________
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________________________________________
________________________________________
________________________________________
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Employment Dates
(Month & year)
From: To:
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Street address
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May we contact
__Yes __No
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City
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Name of Previous Employer
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Company Phone Number
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Employment Dates
(Month & year)
From: To:
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Street address
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May we contact
__Yes __No
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City
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State Zip
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Name of Previous Employer
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Company Phone
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Your Position_____________________________
List your Duties and responsibilities:
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
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Employment Dates
(Month & year)
From: To:
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Street address
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May we contact
__Yes __No
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City
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State Zip
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Name of Previous Employer
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Company Phone
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Your Position_____________________________
List your Duties and responsibilities:
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
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Employment Dates
(Month & year)
From: To:
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Street address
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May we contact
__Yes __No
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City
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State Zip
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I authorize Western, Inc. to complete a background check concerning my previous employment, educational institutions, driving record and other job-related records.
I agree and understand that all Western, Inc. offers of employment are contingent upon successfully completing a physical examination and/or a drug screen. Applicants unwilling to consent to these tests should not proceed with their application for employment with Western Heating & Cooling, Inc.
I agree and understand that any material misrepresentation or omission of a fact in my application may result in rejection of this application or if employed, termination of employment with Western. I certify that the answers provided on this application are true and complete to the best of my knowledge.
Employment with Western, Inc. does not constitute a Contract of Employment. The employee and the Company both reserve the right to end the relationship at any time, with or without cause. No representative of the Company other than the President has the authority to agree to the contrary, and any such Agreement must be in writing and signed by the president.
Signature of Applicant__________________________________ Date______________________________
