DESIRED
POSITION INFORMATION
Position #1
Position #2
Salary Expected
PERSONAL
INFORMATION
Full Name
Social Security No.
Address
(# & Street)
City, State, Zip
Home Phone
Cell Phone
E-Mail address
REFERRAL
SOURCE
Source
JRHAC Employee (Please Write Name)
Relative (Please Write Name)
Other (Please Write)
Friend (Please Write Name)
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Name
EDUCATION
HIGH
SCHOOL
Name
& Location
Grade Avg.
Grade
Completed / Degree Received
COLLEGE
Name
& Location
Grade Avg.
Grade
Completed / Degree Received
OTHER
Name
& Location
Grade Avg.
Grade
Completed / Degree Received
Extracurricular
activities, clubs, and/or other honors:
Other industry
study, postgraduate education, seminars,
military training, etc. which would be applicable
to position applied for
MILITARY
SERVICE
Branch:
Dates
Served:
Highest Rank:
Job:
EMPLOYMENT
HISTORY
CURRENT
OR MOST RECENT EMPLOYER
Employer's Name
Address
Telephone
Employment
Dates
Final Earnings (amount and
whether per hours, year, etc.)
Reason for Leaving
YOUR JOB: Describe your
exact function in the organization. Also
specify significant accomplishments and
noteworthy achievements
Your Manager (Name &
Title) Note: They will not be contacted
without your permission.
2ND
MOST RECENT EMPLOYER
Employer's Name
Address
Telephone
Employment
Dates
Final Earnings (amount and
whether per hours, year, etc.)
Reason for Leaving
YOUR JOB: Describe
your exact function in the organization.
Also specify significant accomplishments
and noteworthy achievements
Your Manager (Name &
Title)
3RD
MOST RECENT EMPLOYER
Employer's Name
Address
Telephone
Employment
Dates
Final Earnings (amount and
whether per hours, year, etc.)
Reason for Leaving
YOUR JOB: Describe your
exact function in the organization. Also
specify significant accomplishments and
noteworthy achievements
Your Manager (Name &
Title)
OTHER
EXPERIENCE, SKILLS, QUALIFICATIONS
List below any other experience,
skills, or qualifications, etc. which you
feel qualify you for the position(s) you
seek:
Professional Licenses and
Certificates:
REFERENCES
(That you know on a business basis)
REFERENCE
#1
Name
Address
Association
Telephone
REFERENCE
#2
Name
Address
Association
Telephone
REFERENCE
#3
Name
Address
Association
Telephone
MISCELLANEOUS
List your recreational activities
/ interests:
What is your ultimate career
goal?:
Are you willing
to travel?
Yes
No
If Yes,
what % of the time?
Are you willing
to relocate?
Yes
No
Any preferences
or geographic limitations?
Have you ever
been convicted of a felony? (Conviction
of a crime will not automatically disqualify
you from employment)
Yes
No
IF
APPLYING FOR ADMINISTRATIVE/SUPPORT POSITION
Are
you able to perform, with or without reasonable
accomodation, office activites including:
Lifting and
carrying objects weighing up to ten (10)
pounds?
Yes
No
Sitting for
extended periods of time up to eight (8)
hours?
Yes
No
Operating office
equipment such as telephones, copy machines,
typewriters, and computer keyboards?
Yes
No
Accessing filing
cabinets?
Yes
No
IF
APPLYING FORA SERVICE / CONSTRUCTION POSITION
Are
you able to perform, with or without reasonable
accomodation, manual service/construction
activites including:
Lifting and
carrying objects weighing up to forty (40)
pounds?
Yes
No
Reaching for,
pushing and pulling construction materials
and equipment?
Yes
No
Climbing ladders
and stairs?
Yes
No
Traversing rough
and uneven surfaces?
Yes
No
Standing, balancing,
walking, kneeling, crawling, stooping, twisting
and squatting to access construction and
equipment areas and to complete construction/service
tasks?
Yes
No
Responding to
audio/visual warnings and alarms?
Yes
No
Responding to
verbal warnings and instructions?
Yes
No
Communicating
verbal warnings and instructions
Yes
No
Do you have
the means to travel to various construction/services
sites?
Yes
No
IMPORTANT
NOTES - PLEASE READ
If any clause(s) contained herein
is found to be unenforceable in a
particular state, such clause(s) is
deemed stricken.
James River Heating and Air is an
Equal Opportunity Employer that employs,
promotes and in all ways accords persons
equal treatment without consideration
to race, color, creed, sex, national
origin or disability.
I understand, in completing this
application for employment, an investigative
report shall be made whereby information
is obtained through personal interviews
with third parties, such as family
members, business associates, financial
sources, academicians, friends, neighbors,
or others with whom I am acquainted.
This investigation will be conducted
in accordance with the regulations
of the Equal Opportunity Commission.
I have the right to make a written
request within a reasonable period
of time for a complete and accurate
disclosure of the information concerning
the nature and scope of the investigation.
I understand my employment with
James River Heating and Air Conditioning,
should I be offered employment, will
not begin until I have proven that
I am authorized to work in the United
States. In addition employment is
deemed to be at the will of both the
employer and employee and may be terminated
by either party.
My submission of this application
indicates that I have read and understand
the preceding items and that I have
made true and accurate statements
of fact to the best of my knowledge
on this application and any supplements
to it. I further understand that any
misrepresentation or falsification
will be considered just cause for
rejection of this application or dismissal
from employment. I understand that
I will be required to sign a Confidentiality
Agreement relevant to the business
operation and activities of my employer.