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NATIONAL HVAC SERVICE
Employment Application

GENERAL INFORMATION
  Intended Branch Location of Employment:
    _____  Bentonville, AR
    _____  Boston, MA
    _____  Lewes, DE
    _____  Little Rock/Hope, AR
    _____  Memphis, TN
    _____  Nashville, TN
    _____  Seaford, DE
    _____  Wilkes-Barre, PA
    _____  Wilmington, DE
  Position Applied For: 
    _____  Service Technician
    _____  Sales-Maintenance
    _____  Sales-Project
    _____  Office Personnel
  Type of Employment: 
        ___ Full-time
        ___ Part-time
  Date of Application:
   ____________

 

PERSONAL INFORMATION
  First Name:    _____________
Middle Initial:  _____________
Last Name:     _____________
  Address line 1:  ________________________
Address line 2:  _________________________
City:  ______________ State: ____   Zip:  _______
  Social Security Number :  ____________
  Telephone Number (home):  _______________
Telephone Number (work):   _______________
  Email Address: ____________________
  Are you legally entitled to work in the United States? 
    __ Yes
    __ No
  Do you have a valid driver's license? 
    __ Yes
    __ No
  Are you able to lift a minimum of 50 pounds?
(Service Technician position only)
 
    __ Yes
    __ No



EDUCATION
  High School attended:   _____________________________________
  Did you graduate? 
     __ Yes
     __  No
Year graduated?  ______
 

#1:  College or Technical School attended: ______________________________

  Did you graduate? 
     __ Yes
     __ No
Year graduated?  ________
  Degree(s) attained: 
    Degree 1:______________________________
    Degree 2:______________________________
   

#2
:  College or Technical School attended:
_______________________________
  Did you graduate? 
     __ Yes
     __ No
Year graduated?  _________
  Degree(s) attained: 
    Degree 1:______________________________
    Degree 2:______________________________
  List any certifications or certificates received: 
____________________________________________
____________________________________________
____________________________________________

 


EMPLOYMENT HISTORY
 (please list most recent positions first)
I have no employment history.

OR

  Employer #1: 
Start Date:  _________  End Date:  _________
  Employer Name: _______________________________
Address line 1:  _______________________________
Address line 2:  _______________________________
City:  _______________  State:  _____  Zip:  _________
  Your position:  ______________________
  Job Duties: 
__________________________________________________________
__________________________________________________________
__________________________________________________________
  Name of immediate supervisor:  _______________________________
  Reason for leaving: 
  ___________________________________________________________
____________________________________________________________
 

Employer #2: 
Start Date:  ___________  End Date:  ____________

  Employer Name:  ______________________________
Address line 1:  _______________________________
Address line 2:  _______________________________
City:  __________________  State:  _____  Zip:  __________
  Your position:  __________________________
  Job Duties: 
___________________________________________________________
____________________________________________________________
____________________________________________________________
  Name of immediate supervisor:  ______________________________
  Reason for leaving: 
    ____________________________________________________________
_____________________________________________________________
   
 

Employer #3: 
Start Date:  __________  End Date:  ___________

  Employer Name:  ______________________________
Address line 1:  _______________________________
Address line 2:  _______________________________
City:  ______________  State:  _____  Zip:  __________
  Your position:  _____________________________
  Job Duties: 
     ___________________________________________________________
____________________________________________________________
____________________________________________________________
  Name of immediate supervisor:  ________________________________
  Reason for leaving: 
     ___________________________________________________________
___________________________________________________________
  May we ask your present employer for a reference? 
  __ Yes
  __ No

 

 
REFERENCES
 (please do not list relatives or former employers) 

Reference  #1: 
Name:  _______________________________________
Address line 1:  ________________________________
Address line 2:  ________________________________
City:  _______________  State:  _____  Zip:  _________

Their occupation:  ___________________________

 

Reference  #2: 
Name:  _______________________________________
Address line 1:  ________________________________
Address line 2:  ________________________________
City:  _______________  State:  _____  Zip:  _________

Their occupation:  ___________________________

 

Reference  #3: 
Name:  _______________________________________
Address line 1:  ________________________________
Address line 2:  ________________________________
City:  _______________  State:  _____  Zip:  _________

Their occupation:  ___________________________

 

OTHER INFORMATION
  Please list any other information that might be helpful in evaluating your qualifications: 
    ________________________________________________________________
________________________________________________________________
________________________________________________________________

 

NOTICE:  By signing below, I hereby certify that to the best of my knowledge and belief the answers given by me to the foregoing questions and all statements made by me in the application are correct.

If employed, I agree that all material created and produced whether in written, graphic or broadcasting form, all inventions, new or changes in processes developed during my employment are the exclusive property of the company to use and/or sell and that subsequent to my employment with this company I will not disclose, use or reveal any confidential information related to the company without first obtaining written consent from an officer of the company.

I hereby apply for employment upon the basis and understanding that such employment may be terminated at any time upon notice given to me personally or sent to my last known address.

X_________________________________________________          Date: _________________________
   Signature

 

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National HVAC Service
Stonewood Commons
101 Bradford Road, Suite 340
Wexford, PA  15090

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