Residential & Commercial Trusted HVAC, Heating & Air Conditioning Contractor,

Call 678-221-4328 for Emergency 24 Hour
Heating and Cooling Repairs or Service.

Please answer all questions. Resumes are not accepted in lieu of completion of this application.

Note: This document was designed to use with several types of positions. Some questions may not be completely applicable to the job/position you are seeking; however, we ask that you fully complete all areas of information.

Applicant Information

Position(s) Applied For

Date of Application

Name:

Last		First		M.I.
Other

Address
City
State
Zip Code

Telephone #		Other Phone #
Email Address

Are you under the age of 18?

Note: If yes, you may be required to furnish proof of exemption or partial waiver as detailed by your State Child Labor Law.

Have you previously filed an application with this company?
If yes, what date?	//

Have you previously been employed by this company?
If yes, what date?	//

Please list any relatives or friends who are employed at this work site and their relationship to you.

Do you have the legal right to work in the United States?

Note: You will be required to provide appropriate document(s) for completion of the I-9 at the time of employment.

What date are you available to start?

Type of employment desired

Do you have a reliable means of transportation?

(which will enable you to be at work as required)

Will you work overtime if asked?
If required, are you able to work evenings?
If required, are you able to travel?

Are there any hours, shifts or days you will not work?
If yes, explain

Have you ever been convicted of a felony/misdemeanor or pleaded nolo contendere (no contest) to a felony/misdemeanor, or pleaded guilty to a felony/misdemeanor, or been found guilty of a felony/misdemeanor? (Include any and all instances of these foregoing even if adjudication was withheld.)

Do you have any pending criminal charges?
If yes, provide details including dates

Please Note: The fact that you are awaiting trial or have a convicted record will not necessarily exclude you from consideration.

Skills and Qualifications

Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job related functions in the position for which you are applying

Other Languages (Please indicate if read, written, or spoken.)

Driver’s License (only complete if required for position)

Do you have a valid driver’s license?

If yes, answer the following:

Driver’s License #		Class
State Issued		Expiration Date	//

Education Data

High School:

Name		Address
Years Completed		Degree

Major Course of Study:

College:

Name		Address
Years Completed		Degree

Major Course of Study:

Graduate School:

Name		Address
Years Completed		Degree

Major Course of Study:

Trade, Bus., Night or Correspondence:

Name		Address
Years Completed		Degree

Major Course of Study:

Honors Received

Personal References

Please provide two individuals, not relatives, whom you have known at least 1 year.

Reference 1:

Name
Telephone
Years Known
Address

Reference 2:

Name
Telephone
Years Known
Address

Employment Experience

List all your previous employers (most recent first). Account for all time periods including unemployment, self-employment and military service. This section must be completed in full in addition to any attached resume.

Employer 1:

Employer		Address
Date Hired		Date Left
Supervisor		Telephone #
Starting Salary		Final Salary
Job Title		Work Performed

Reason for leaving

Employer 2:

Employer		Address
Date Hired		Date Left
Supervisor		Telephone #
Starting Salary		Final Salary
Job Title		Work Performed

Reason for leaving

Employer 3:

Employer		Address
Date Hired		Date Left
Supervisor		Telephone #
Starting Salary		Final Salary
Job Title		Work Performed

Reason for leaving

Please provide an explanation for any lapse of employment

Have you ever been dismissed or forced to resign from an employment?
If yes, explain.

I , agree to all rules and regulations of the Company.

We are a Georgia Conditioned Air Contractor and we service both residential and commercial customers. License# CN210405

Request Service Today:

678-221-4328 to schedule a
FREE Consultation, or Please
Fill out the form to get started

Gagne Heating &Air Conditioning

Residential & Commercial Trusted HVAC, Heating & Air Conditioning Contractor,

Request Service Today: