Employment Application

Position applying for

Date

YYYY

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Have you ever been employed here before?

Yes

Are you legally eligible for employment in this country?

Yes

Date available for work

YYYY

Type of employment desired

Full-Time

Part-Time

Temporary

Co-Op

Are you able to work overtime and weekends

Yes

Can you travel to local job sites?

Yes

Do you have a valid driver's license?

Yes

Are you willing to undergo substance abuse testing?

Yes

This job requires strenuous physical work such as heavy lifting, are you able to perform such work?

Yes

Have you been convicted of a crime in the last ( 7 ) years?

Yes

If yes, please explain

If you are under 18, and it is required, can you furnish a work permit?

Yes

If no, please explain

Education

*If you submit a resume you can skip the Education section

Name and Location

High School

Years Completed

Did you graduate?

Name and Location

College

Years Completed

Did you graduate?

Name and Location

Trade School

Years Completed

Did you graduate

Work Experience

List present and former employers beginning with the most recent. *If you submit a resume you can skip the Work Experience section.

Employer 1 Name

Date From - To

Job Title

Address

Immediate Supervisor & Title

Reason for leaving

Summarize job responsibilities

Employer 2 Name

Date From - To

Job Title

Address

Immediate Supervisor & Title

Reason for leaving

Summarize job responsibilities

Employer 3 Name

Date from - to

Job Title

Address

Immediate Supervisor & Title

Reason for leaving

Summarize job responsibilities

Personal References 1

First Name

Last Name

Phone

(###)

###

####

Years knows

Personal References 2

First Name

Last Name

Phone

(###)

###

####

Years Known

Personal References 3

First Name

Last Name

Phone

(###)

###

####

Years Known

Skills and Qualifications

Summarize any training skills, licenses, and/or certificates that may qualify you in the following categories.

Sheet Metal

Layout capabilities:

Welding Skills:

Fabrication equipment:

What types of metal have you worked with?

Field installation experience:

Piping

Fitting Skills:

threaded & butt weld

Welding skills:

Site layout:

Plumbing skills:

Plumbing licenses or certificates:

What types of pipe have worked with?

Millwright

Rigging skills:

Welding skills:

Site layout:

Misc. Skills

Can you read drawings (Blueprints)?

Lift trucks:

Manlifts:

Cranes:

Trucks - Heavy Hauling:

Do you have any supervisory skills?

Do you have any estimation/job costing skills?

Summarize any safety training you have had:

To be completed by all applicants - Please read carefully before signing

I certify that the information contained in this application and in any resume provided by me or any party representing my interests is correct and complete to the best of my knowledge. I understand that any false statements, misrepresentations or omissions made by me on the application or any supplement thereto, will be sufficient grounds for rejection of this application or discharge after employment. I give the employer the right to obtain pertinent information concerning me from former employers and others, and I release all those providing or requesting such information from any liability that may arise by truthful disclosures or such investigations. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time with or without cause and without prior notice, except as may be required by law. This application does no constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representation of the employer, other than an authorized officer, has the authority to make any assurances to contrary. I further understand that any such assurances must be in writing and signed by an authorized officer. I understand it is the company's policy not to refuse to hire a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA. I am understand that if I'm hired, I will be required to provide proof and legal work authorization.

Your signature acknowledges you have read and agree to the material above.

Applicant's Signature

By typing in your First and Last name you acknowledge you are signing this application.

We appreciate you taking the time to apply.

We are currently in the process of taking applications. If you are selected for an interview, our human resources department will be in contact within a week.

Thank you again.

Heisey Mechanical Ltd.

Heisey Mechanical, Ltd.