• • Employment One

    Employer
  • Address
  • Position
  • Duties Performed
  • Reason for Leaving?
  • Dates Worked
  • City
  • State
  • Zip Code
  • Rate of Pay
  • Supervisor's Name and Title & Contact
  • May we contact this employer?
    • Yes
    • No
  • Do you have more employment history to add?
    • Yes
    • No

  Employment Two

  Employer

  Address

  Position

  Duties Performed

  Reason for Leaving?

  Dates Worked

  City

  State

  Zip Code

  Rate of Pay

  Supervisor's Name and Title & Contact

  May we contact this employer?

  • Yes
  • No

  Do you have more employment history to add?

  • Yes
  • No

  Employment Three

  Employer

  Address

  Position

  Duties Performed

  Reason for Leaving?

  Dates Worked

  City

  State

  Zip Code

  Rate of Pay

  Supervisor's Name and Title & Contact

  May we contact this employer?

  • Yes
  • No

• • Reference One

    Name
  • Title
  • Company
  • Phone

• • Reference Two

    Name
  • Title
  • Company
  • Phone

• • Reference Three

    Name
  • Title
  • Company
  • Phone

• • School One

    School Name
  • School Location
  • Years Attended
  • Year of Graduation
  • Degree Receieved
  • Major

• • School Two

    School Name
  • School Location
  • Years Attended
  • Degree Receieved
  • Major

• • School Three

    School Name
  • School Location
  • Years Attended
  • Degree Receieved
  • Major
• Other training

  Other training, certifications or licenses held

• • I certify that I have fully and accurately completed this application to the best of my knowledge.
  • Please enter initials.
• • I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, and I release all such parties from all liability from any damages which may result from furnishing information to Gary’s Heating and Air Conditioning, Inc.
  • Please enter initials.
• • I understand and agree that I may be required to provide my driver’s license, social security number or other work authorization information, and date of birth to facilitate a background check.
  • Please enter initials.
• • I understand and agree that the discovery of false or misleading information may result in disqualifying me from consideration of employment.
  • Please enter initials.
• • In the event of my hire, I understand and agree that the discovery of false or misleading information given on my application or during any interview may result in discharge.
  • Please enter initials.
• • I agree to undergo any type of drug and/or alcohol testing that Gary’s Heating and Air Conditioning, Inc. may require, at any time.
  • Please enter initials.
• • I understand and agree that submission of this application does not necessarily mean that I will be hired, and that if I am hired, my employment will be “at will.” This application cannot be construed as an offer of employment or an employment contract.
  • Please enter initials.

Please note that a "Yes" answer to any of the following questions will not necessarily disqualify you from employment. This company will only exclude you from employment if we determine that your criminal history has a bearing on the job for which you are applying and it is a business necessity to exclude consideration of your application. Factors such as your age at the time of the offense, how long ago the offense occurred, the seriousness and nature of the offense, and the relevancy of the offense to the job you will be performing will be considered when making any employment decisions. Arrests will not be considered, only convictions.

• 1. Have you ever been convicted of a crime (felony or misdemeanor, other than minor traffic violation)? (Do not include convictions that have been sealed or expunged pursuant to a court order, but do include those offenses to which you pleaded guilty, no contest or received deferred adjudication or probation).
  • Yes
  • No
  Please select one.
• Please explain any "Yes" answer. Include the date, place and nature of the conviction and any punishment ordered. Use additional paper if necessary.
• 2. Are you currently under indictment or awaiting trial for any criminal offense or on probation or parole?
  • Yes
  • No
  Please select one.
• Please explain any "Yes" answer. Use additional paper if necessary.
• 3. Have you ever committed an act of violence in the workplace?
  • Yes
  • No
  Please select one.
• Please explain any "Yes" answer. Use additional paper if necessary.
• I understand that, as a condition of my consideration for employment with Gary’s, or as a condition of my continued employment with Gary’s, Gary’s may obtain a consumer report that includes, but is not limited to, my criminal history, driving records, social security verification, employment and education verifications, any other public records and any other information bearing on my character, general reputation, personal characteristics and trustworthiness.
• I hereby authorize and consent to Gary’s procurement of such a report. I understand that, pursuant to the federal Fair Credit Reporting Act, Gary’s will provide me with a copy of any such report if the information contained in the report is, in any way, to be used in making a decision regarding my fitness for employment with Gary’s. I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report.
• I understand that if Gary’s determines that my criminal record is relevant, I will be given notice that I have been screened out because of a criminal conviction; I will be given an opportunity to demonstrate that the exclusion should not be applied due to my particular circumstances; and Gary’s will consider whether the additional information I provided warrants Gary’s making an exception in my case.
• I understand the above information about the company’s criminal history check process. I swear that the information I have provided about my criminal history is true and correct. The information I have provided about my criminal history (if any) is complete and fully explained.
• I understand that any misrepresentation, deception, or false statement made during the employment process may result in my not being considered for employment, and if not discovered until after my becoming employed, is grounds for, and may result in, my immediate termination.
• I have read, understand, and by my typed name below consent to these statements. Signature (Enter Full Name)
  Please sign.
• Today's Date
  Please enter today's date.