Midland Heating & Air Conditioning, Inc.

Midland Heating and Air Conditioning, Inc.

Employment Application

*Programs, services, and employment are equally available to everyone. Please inform Management if you require reasonable accommodation for the application or interview.*

Position Applied for: How were you referred to us?

APPLICANT DATA:

Full Name: Date Available to Start (dd/mm/yy):

Address: City: State:

Zip Code: Phone: Cellular/Other Phone:

E-mail: Desired Salary:

Have you ever worked for this company? Yes No If yes, when?

Are you a citizen of the United States? Yes No

If not, are you legally allowed to work in the United States? Yes No

Type of employment desired: Full-Time Part-Time Temporary Seasonal

Have you ever pleaded "guilty", "no contest", or been convicted of a crime? Yes No

If yes, give dates and details:

*Answering "yes" to this question does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.*

Driver's license number: State:

Special Skills or Qualifications:

PREVIOUS EMPLOYMENT (begin with most recent position):

Dates of Employment (dd/mm/yy): From: To: Position(s) Held:

Company: Address:

Phone: Supervisor: Title:

Responsibilities:

Starting Salary and Title: Ending Salary and Title:

Reason for Leaving:

May we contact this employer for a reference? Yes No

Dates of Employment (dd/mm/yy): From: To: Position(s) Held:

Company: Address:

Phone: Supervisor: Title:

Responsibilities:

Starting Salary and Title: Ending Salary and Title:

Reason for Leaving:

May we contact this employer for a reference? Yes No

Dates of Employment (dd/mm/yy): From: To: Position(s) Held:

Company: Address:

Phone: Supervisor: Title:

Responsibilities:

Starting Salary and Title: Ending Salary and Title:

Reason for Leaving:

May we contact this employer for a reference? Yes No

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

I have read and understood the above statements, and I agree to the terms: Yes *Required Field