Mechanical • Plumbing • Medical Gas • Electrical • Refrigeration Contractors
Celebrating Our 60th Year in Business 1957 ~ 2017

Application for Employment

Personal Information






Employment Desired


 Yes  No
 Yes  No

 Lumberton, NC  Raleigh, NC

 Yes  No

Education History

High School



College



Trade, Business or Correspondence School



General Information



Former Employers

(List below last four employers, starting with last one first)

Employer 1



Employer 2



Employer 3



Employer 4



References

(List below the names of three business references not related to you, whom you have known at least one year)

Person 1


Person 2


Person 3


Resume

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertimnent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also undstand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by the authorized company representative. The Waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act(ADA) and other relevant federal and state laws. I understand that a consumer credit report or criminal record check may be necessary prior to my employment. If such reports are required. I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.
I have read and agreed to the authorization terms above.


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