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Scott Smith
2018-08-09T18:22:15+00:00
Step 1 of 6
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Name
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Address
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Email
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Primary Phone
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Date Available for Employment
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Date Format: MM slash DD slash YYYY
Are you at least 18 years of age?
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No
Are you authorized to work in the United States?
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No
Position being applied for:
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What is your desired wage?
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Can you perform the essential functions of the job for which you are applying?
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Which are you available to work?
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Full Time
Part Time
Do you have a valid Driver's License?
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Yes
No
Do you have reliable transportation?
*
Yes
No
Have you been convicted of a Felany or a Misdemeanor?
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Yes
No
Please Explain
*
Many of our jobs require working in tight spaces, extreme temperatures, and heavy lifting of at least 75 lbs Is there any reason you WOULD NOT be able to do this?
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Yes
No
Please Explain
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Skills
Applicant Special Skills, Qualifications & Considerations:
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Summarize specific skills, employment experience or qualifications related to the job you are seeking. (Please exclude information which discloses membership in a protected class.)
Education
High School
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Highest Grade Completed
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Please Select
9
10
11
12
Do You Have an Additional School to Add? - 1
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No
Name of School - 1
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Type of School - 1
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Technical School
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Years Completed - 1
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1
2
3
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Degree / Certificate / Field of Study - 1
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Do You Have an Additional School to Add? - 2
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Name of School - 2
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Type of School - 2
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Technical School
College
Other
Years Completed - 2
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Please Select
1
2
3
4
Degree / Certificate / Field of Study - 2
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Do You Have an Additional School to Add? - 3
*
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No
Name of School - 3
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Type of School - 3
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Please Select
Technical School
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Other
Years Completed - 3
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Please Select
1
2
3
4
Degree / Certificate / Field of Study - 3
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Do You Have an Additional School to Add? - 4
*
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Name of School - 4
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Type of School - 4
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Technical School
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Years Completed - 4
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1
2
3
4
Degree / Certificate / Field of Study - 4
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Employment History
Are you currently employed?
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Yes
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May we contact your current employer?
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Current / Most Recent Employer
Company Name:
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Address
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Ending Salary
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Employment Start Date
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Date Format: MM slash DD slash YYYY
Employment End Date
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Enter today's date if currently employed.
Date Format: MM slash DD slash YYYY
What do / did you like MOST about this job?
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What do / did you like LEAST about this job?
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Reason for leaving:
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Do you have a previous employer information to add?
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No
Please include all previous employers.
Second Employer
Company Name
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Position / Job Title:
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Job Duties:
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Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Supervisor's Name
*
Company / Supervisor's Phone Number
*
Starting Salary
*
Ending Salary
*
Employment Start Date
*
Date Format: MM slash DD slash YYYY
Employment End Date
*
Enter Today's Date if Currently Employed
Date Format: MM slash DD slash YYYY
What did you like MOST about this job?
*
What did you like LEAST about this job?
*
Reason for leaving:
*
Do you have a previous employer information to add?
*
Yes
No
Please include all previous employers.
Third Employer
Company Name
*
Position / Job Title:
*
Job Duties:
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Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Supervisor's Name
Company / Supervisor's Phone Number
*
Starting Salary
*
Ending Salary
*
Employment Start Date
*
Date Format: MM slash DD slash YYYY
Employment End Date
*
Date Format: MM slash DD slash YYYY
What did you like MOST about this job?
*
What did you like LEAST about this job?
*
Reason for leaving:
*
Do you have a previous employer information to add?
*
Yes
No
Please include all previous employers.
Fourth Employer
Company Name
*
Position / Job Title:
*
Job Duties
*
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Supervisor's Name
Company / Supervisor's Phone Number
*
Starting Salary
*
Ending Salary
*
Employment Start Date
*
Date Format: MM slash DD slash YYYY
Employment End Date
*
Date Format: MM slash DD slash YYYY
What did you like MOST about this job?
*
What did you like LEAST about this job?
*
Reason for leaving:
*
References
Please list three (NON-FAMILY) references that are familiar with your qualifications, actual work history and abilities.
Reference #1 Name
*
Reference #1 Phone and/or Email
*
Reference #1 Company / Relationship
*
Reference #2 Name
*
Reference #2 Phone and/or Email
*
Reference #2 Company / Relationship
*
Reference #3 Name
*
Reference #3 Phone and/or Email
*
Reference #3 Company / Relationship
*
Any additional information that you feel is important to share with us for review. (Optional)
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE SIGNED AND DATED ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THESE STATEMENTS, PLEASE ASK BEFORE SIGNING.
I certify that all answers and statements I have made on this application (and resume or other supplementary materials) are true and complete, without ommisions. I understant that and false information will be grounds for refusal to hire or for immediate discharge if I am employed. This employment application is used to notify me that the nature and scope of an investigation, if one is conducted, could include such general identification information as residence verification, and, as applicable, information concerning my employment, education, general reputation, character, personal characteristics, and habits, and with third parties such as family members, neighbors, friends, associates, former employers, financial sources, and custodians of official records. Only job-related information developed from such a report will be considered in evaluating my employment application or continued employment. I hereby authorize these persons, companies, organizations or corporations to answerall questions or release any information regarding the items listed in this paragraph. I hereby release then from any liability and hold them harmless from any claim for releasing any thuthful information within their knowledge and or records. I authorize Smith Air Conditioning, Inc. to release to any person, form, entity or organization with which I may seek employment in the future, and truthful information concerning my work experience with Smith Air Conditioning, Inc.. I hereby release and hold Smith Air Conditioning, Inc. harmless from any claim for releasing any truthful informationwithin its knowledge and or records.
*
Yes
No
I understand that my employment may be subject to the satisfactory results of any pre-employment examination required by Smith Air Conditioning, Inc., including a mandatory blood, hair, and/or urine test to detect drug usage. I will be resonsible for familiarizing myself wih all the rules and regulations of Smith Air Conditioning, Inc. as they presently exist or are later modified. I recognize that my employment can be terminated, at the discretion of the company or at my option, without notice, at any time, except as specifically set forth in writing in a current individual employment agreement.
*
Yes
No
I understand that no representative of Smith Air Conditioning, Inc. has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits or terms and conditions of employment, except as specifically stated in a current written agreement signed by the President.
*
Yes
No
Was this form completed by applicant or other? If other, please provide name and relationship.
*
Applicant
I HAVE HAD AS OPPORTUNITY TO HAVE MY QUESTIONS ABOUT THE CONTENT OF THIS STATEMENT AND INTENT ANSWERED. FURTHERMORE, I UNDERSTAND THESE TERMS.
*
Any questions regarding policies and or terms should be directed to the business office by calling 337-363-1866 prior to completion of application.Electronic Signature of Applicant:
Authorization for MVR Review
The information below is separate from the application. This information is optional and may be withheld at this time.
I understand that Smith Air Conditioning may obtain a copy of my Motor Vehicle Record (MVR) as part of their evaluation of my job application and/or my employment to determine my eligibility to drive a company vehicle or a personal vehicle for company use. I have been informed that a Motor Vehicle Report may be periodically obtained on me as deemed necesary to re-evaluate my eligibity. I acknowledge the receipt of the above discolsure and authorize Smith Air Conditioning or its designated agent to obtain a Motor Vehicle Report. This authorization is valid as long as I am a job applicant or an employee and may only be rescinded in writing.
*
Yes
No
Driver's License Number
Driver's License State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Date Of Birth
Date Format: MM slash DD slash YYYY
Name / Signature of Applicant