Broadview Heating and Air Conditioning Inc

Broadview Heating and Air Conditioning Inc.

Tom Olecki Telephone 440-526-7310

Manager Fax 440-526-7340

4111 E. Royalton Road

Broadview Heights, Ohio

Date

Applying for:

Position applying for:

Have you ever been employed by or made application with Broadview Heating before? Yes No

Name:

First: MI: Last:

Address:

Street:

City: State: Zip:

Contact Information:

Phone: Cell: Best time to contact:

Email address:

Hours of Availability:

Are you willing to work overtime in our busy periods?

When are you available to start working?

Are you willing to attend FREE training classes on your own time?

Personal Information:

Social Security #: Drivers License#:

Do you have a clear driving record? Yes No

If no, please explain.

It is the policy and practice of Broadview Heating to select new employees on the basis of their qualifications, without regard to national origin, age, race, sex, color, religion, marital status, disability or any other characteristic protected by law.

Employment in the position that you are applying for may be contingent upon the completion of testing for the presence of illegal substances and/or a physical exam. If you are offered the position, are you willing to take, and do you consent to, drug testing and/or a physical exam? Yes No

Have you ever been convicted of a felony?

A record of criminal convictions will not necessarily bar you from employment. In making our decision, we will consider many factors, such as age and time of the offense involved, the seriousness and nature of the violations, and whether you have been rehabilitated. Yes No

If yes, please explain.

Miscellaneous Information:

Do you have any physical limitations/restrictions?

How is your hearing?

Are you willing and able to lift heavy objects? Yes No If not, what is your restriction?

Are you willing and able to climb ladders? Yes No

Are you willing and able to work on rooftops? Yes No

Military:

If no experience in this section, please leave blank.

Branch of Service:

Dates: to

Command:

School Experience:

Name of High School: Location:

Did you graduate? Yes No GED? Yes No

If you have attended or are currently attending college, please fill out the following:

College attended w/location / Area of Study? / Degree acquired? / Did you graduate?
Yes No
Yes No
Other Training/Certifications?

What are your hobbies or other interests?

Employment History: (Please list most recent employment FIRST)
Employer Name/Address: / Industry: / Phone Number: / Supervisor / Can we contact?
Yes No
Dates of Employment: / Salary / Position Held? / Responsibilities/work performed?
$/Hr /Year
Reason for Leaving:
Employer Name/Address: / Industry: / Phone Number: / Supervisor / Can we contact?
Yes No
Dates of Employment: / Salary / Position Held? / Responsibilities/work performed?
$/Hr /Year
Reason for Leaving:
Employer Name/Address: / Industry: / Phone Number: / Supervisor / Can we contact?
Yes No
Dates of Employment: / Salary / Position Held? / Responsibilities/work performed?
$/Hr /Year
Reason for Leaving:
Employer Name/Address: / Industry: / Phone Number: / Supervisor / Can we contact?
Yes No
Dates of Employment: / Salary / Position Held? / Responsibilities/work performed?
$/Hr /Year
Reason for Leaving:

What type of specialized skills do you have for the position that you are applying for?

What type of specialized tools related to this position do you currently own?

References: (Do not include relatives)
Name: / Occupation:
Address: / Phone:
Name: / Occupation:
Address: / Phone:
Name: / Occupation:
Address: / Phone:

Wo

I certify that the information furnished in this application and any supporting documents is true and complete to the best of my knowledge and belief, and I understand that any misrepresentation or omission of material fact on this or any other record submitted pertinent to employment could constitute grounds for dismissal.
I authorize my previous employers, schools, credit agencies, and other persons named above to give any information they may have regarding me, whether or not it is on their record. I hereby release said employers, schools, credit reporting agencies, or persons from all liability for any damage resulting from this information. Furthermore, I hereby release this employer from any/all liability of whatever kind and nature which, at any time, could result from obtaining and making an employment decision based on such information.

I Agree

Signature:______