Jobs - Burton A/C Heating and Plumbing

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Date

MM/DD/YYYY

APPLICANT INFORMATION

Last Name *

First Name *

Middle Name

Street Address *

Apartment/Unit #

City *

State *

Zip *

Phone *

Email

Birthday

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

Have you ever worked for this company?

Yes

No

If so, when?

Have you ever been convicted of a felony?

Yes

No

If so, when?

Do you have a valid Drivers license? *

Yes

No

EDUCATION

High School

Address

From

To

Did you graduate?

Yes

No

Degree

College

Address

From

To

Did you graduate?

Yes

No

Degree

Other

Address

From

To

Did you graduate?

Yes

No

Degree

PROFESSIONAL REFERENCES

Previous Plumbing / HVAC technician you’ve worked with or currently know.

Full Name

Occupation

Company

Phone

Name

Occupation

Company

Phone

Name

Occupation

Company

Phone

PERSONAL REFERENCES

Please list three personal references..

Name

Occupation

Company

Phone

Name

Occupation

Company

Phone

Name

Occupation

Company

PREVIOUS EMPLOYMENT

Company 1

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Company 2

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Company 3

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

MILITARY SERVICE

Details

From

To

Rank at Discharge

Type of Discharge

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature *

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