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            Application for Employment

Pre-Employment Questionnaire
Equal Opportunity Employer

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T S  Heat and Air
8484 NW 39th Expressway
Bethany, Oklahoma 73008

Personal Information
Date
 Last Name
First Name
  
Present Address
 City
 State
 Zip
Permanent Address
 City
 State
 Zip
Phone Number
 Referred By
  
Employment Desired
Position
 Date You Can Start
 Salary Desired
Are You Employed?
Yes   No		 If Yes, may we inquire of your present employer?
Yes   No
Have you ever applied to this company before?
Yes   No		 If Yes, where?
 If Yes, when?
Education History
Name & Location of School Years
Attended		 Did you
Graduate?		 Subjects
Studied
Grammar School Name

Grammar School Location
 Yes No
High School Name

High School Location
 Yes
No
College Name

College Location

 		 Yes
No
Trade, Business or
Correspondence School Name

Trade, Business or
Correspondence School Location

 

 Yes
No

General Information
Subjects of Special Study/Research Work or Special Training/Skills
US Military or Naval Service
 Rank

Former Employers
Starting with the last one first, list your previous four (4) employers
Date Start
 Date End
 Name of Employer
 Address of Employer
 Salary
 Position
Reason for Leaving
 
Date Start
 Date End
 Name of Employer
 Address of Employer
 Salary
 Position
Reason for Leaving
 
Date Start
 Date End
 Name of Employer
 Address of Employer
 Salary
 Position
Reason for Leaving
 
Date Start
 Date End
 Name of Employer
 Address of Employer
 Salary
 Position
Reason for Leaving

References
List below the names of three persons not related to you, whom you have known at least one year.
Name Address Business Years Known
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 pertinent information they may have, personal or otherwise, and release the company from al liability for any damage that my 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 American with Disabilities Act (ADA) and other relevant federal and state laws."

Date:    Applicant Name: