Employment Application
Personal Information
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Name (Last Name First)
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Address
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City
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State
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Postal Code
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Phone
Email Address
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Position Applying For
Oil Driver
HVAC Technician
Burner Technician
Plumber
Mechanic
Secretary
United States Military Service
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Are you legally authorized to work in the United States?
Yes
No
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Have you ever been convicted of a felony?
Yes
No
If yes, please explain.
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Looking for
Part-Time
Full-Time
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Date you can start
Education History
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Highest Level of Education
GED
High School
Associates Degree
Bachelors Degree
Masters Degree
Technical Trade Degree
Licensure/Certificates - Subjects of Special Study - Special Training/Skills
Employment History
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Are you currently employed? May we contact your employer?
Employer/Supervisor's Name
Phone
From (MM/YYYY) To (MM/YYYY)
Position
Salary
Employer/Supervisor's Name
Phone
From (MM/YYYY) To (MM/YYYY)
Position
Reason for Leaving
Employer/Supervisor's Name
Phone
From (MM/YYYY) To (MM/YYYY)
Position
Reason for Leaving
References
Name/Title
Phone
Name/Title
Phone
Name/Title
Phone
Please note any additional comments you would like to submit with your application.
Authorization
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"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 may have, personal or otherwise, and release the company from all liability for any damages that may result from utilization of such information.
I also understand 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 an authorized company representative.
This 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 the content of this authorization and by checking this box indicate my consent of such.
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Signature Implied by Typing Full Name
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Date
Please submit a copy of your resume online or fax directly to our office at 413-648-5236. Please note on the fax cover sheet that your application has been submitted online.
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Indicates Response Required
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