Application For Employment

ALL APPLICANTS ARE CONSIDERED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, PHYSICAL OR MENTAL DISABILITY, OR ANY OTHER LEGALLY PROTECTED STATUS.
Last Name First Name Middle Name
Present Street Address
City State Zip
Home Phone Business Phone Cell Phone
E-Mail
Note: This email address will be used to send you a news about the status of your application, as well as your interview time, etc. You will also be contacted by telephone within two weeks if your application is accepted.

Age And Citizenship

Are you at least 18 years of age? Yes No
Are you authorized to work in the U.S.? Yes No
Note: Proof of citizenship or immigration status will be required upon employment.

Other Information

Do you have a valid driver's license? Yes No
*Drivers License # *State *Date of Birth
*Social Secruity Number
*Have you ever been convicted of a crime other than minor traffic violations? Yes No
* Required is yes: Explain:
*Have you ever been convicted of a felony? Yes No
* Required is yes: Explain:
*Have you ever applied or worked for HSI before? Yes No
*Required if yes: Date of Application

Education

High School Last Attended City / State
Did you graduate? Yes No
Business Vo-Tech or Other School City / State
Did you graduate? Yes No
University or College Last Attended City / State
Major Degree Credit Hours
Did you graduate? Yes No
Foreign Languages You Speak Fluently

Employment Desired

Type of Employment Desired Full-Time Part-Time Temporary
Position Preferred Shift Date You Can Start
Would You Be Available To Work Overtime? Yes No
Referred By:

Employment History

List Most Current Company First
Company Name City & State Type of Business
Duties Position or Title
Dates of Employment
From (MO/YR) To (MO/YR) Salary
Reason for Leaving
May We Contact This Employer For A Reference? Yes No
Company Name City & State Type of Business
Duties Position or Title
Dates of Employment
From (MO/YR) To (MO/YR) Salary
Reason for Leaving
May We Contact This Employer For A Reference? Yes No
Company Name City & State Type of Business
Duties Position or Title
Dates of Employment
From (MO/YR) To (MO/YR) Salary
Reason for Leaving
May We Contact This Employer For A Reference? Yes No

Experience or Training

Labor

Shop Help
Assembly
Grinding
Steel Shop
Fab Shop
Soldering
Janitorial
Auto Repair
Read Blueprints
Read Tape Measure

Warehouse

Labor
Forklift Experience
Forklift Certificate
Overhead Crane
Mobile Crane
Material Handling
Machine Maintenance

Welding

Mig
Tig
Stick
Fluxcore
Spray-Arc
Sub-Arc
Pipe Fitter
Structural Fitter
Grinder
Read Blueprints
Instrumentation
Inspection
Tube Bending
Steam Card
Code Welder
Certified (Any)
Mech License (Any)

Industrial Painting

Epoxy
Urethane
Zinc
Enamels
Conventional
Airless
Hydraulic
Sandblasting
Bead Blasting
Shot Blasting
Prep

Machining

Drill Press
Press Break
Machine Operator
Hydro Testing

Additional Background Information

Please provide the names of three professional references
Name Company
Relationship Phone Years Known
Name Company
Relationship Phone Years Known
Name Company
Relationship Phone Years Known





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 you to make such investigations and inquiries of my personal, employment, educational, financial, and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.

I certify that my answers are true and complete to the best of my knowledge.

Digital Signature
Please sign this form by typing your full legal name in the space above. All applications require a signature before being considered for employment.

Copyright 2012. All Rights Reserved. Heater Specialists, LLC