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If you are hired
by Custom Aire, Inc., you will be employed on an at-will
basis. As an at-will employee, you may terminate your employment
at any time, for any reason, with or without cause, notice
or prior warning or discipline. Similarly, if you are hired,
Custom Aire, Inc. will have the right to terminate your
employment at any time, for any reason, with or without
cause, notice or prior warning or discipline. No Custom
Aire, Inc. supervisor or manager has the authority to offer
or promise anything other than at-will employment, and no
subsequent transfer, promotion or change in you employment
will affect your at-will employment status.
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Positions Applied For: |
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Date of Application: |
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Name:
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First: |
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Middle: |
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Last: |
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Current Date: |
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Have you ever been
known by another name or by an alias: |
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If yes, what: |
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Present Address: |
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Permanent Address: |
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Social Security No. |
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Home Phone No. |
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Other phone at which
you can be reached (present work # if employed) |
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If hired, can you furnish proof
that you are 18 years of age, or older? |
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If hired, can you furnish proof
that you are eligible to work in the United States? |
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Have you applied for work or
worked at our Company before? |
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Are you available to work at
any time of the day or week as needed? |
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If not, please explain limitations: |
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Date You Can Start: |
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Desired Wage or Salary: |
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Have you ever been convicted
of a crime? (minor traffic violations may be omitted.) |
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If yes, provide the date, location
and circumstances and identify the offense(s) and jurisdictions(s): |
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If you wish to be considered for positions
that require driving,
please answer these questions:
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Do you have a current, valid
and unrestricted driver's license(s)? |
Yes
No |
If yes, what class of license(s)
and which state(s)? |
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Have you received DWI, DUI or
other driving violations within the last two years? |
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If yes, please explain: |
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Please provide education information if you
wish to be considered now or in the future for a supervisory
or office position: |
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Have you served in the Military? |
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If Yes, which Branch and rank and nature
of discharge? |
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Briefly describe any military duties related
to position applied for: |
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Present Membership in National Guard or Reserves? |
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| Have you ever worked in a position similar
to the one for which you are applying? |
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If experienced in using tools or equipment
which might be helpful on this job, or if you hold a state
journeyman or any relating public or private licenses, certifications
or competency cards, please provide details, including issuing
authority and any license or other numbers: |
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Where have you gained this experience? |
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Are you acquainted with anyone who is or
was employed by our Company? |
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If yes, who, and how do you know them? |
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Work History -- List all employers
during last ten years, with present or last employer first. |
Employer |
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Name: |
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Address |
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Telephone: |
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Position: |
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Duties: |
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Final Pay Rate: |
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Supervisor's Name & Title: |
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Dates of Employment |
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Reason for leaving: |
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Employer 2 |
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Name: |
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Address: |
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Telephone: |
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Position: |
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Duties: |
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Final Pay Rate: |
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Supervisor's Name & Title: |
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Dates of Employment |
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Reason for leaving: |
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Employer 3 |
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Name: |
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Address: |
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Telephone: |
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Position: |
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Duties: |
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Final Pay Rate: |
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Supervisor's Name & Title: |
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Dates of Employment |
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Reason for leaving: |
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Employer 4 |
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Name: |
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Address: |
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Telephone: |
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Position: |
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Duties: |
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Final Pay Rate: |
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Supervisor's Name & Title: |
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Dates of Employment |
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Reason for leaving: |
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List all periods of unemployment since you
finished school. |
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How did you spend this time? |
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Have you ever been fired, laid off or asked
to resign by an employer? |
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If yes, please explain: |
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May we contact the employers listed above? |
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If no, please explain: |
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Are you on layoff status and eligible for
recall or eligible for referral for hire by a hiring hall
or employment service? |
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References: Give the names
of three persons not related to you, whom you have known at
least one year, as references we can contact. |
Individual's Name: |
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Phone: |
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Complete Address: |
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Type of Business: |
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Years Acquainted: |
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Individual's Name: |
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Phone: |
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Complete Address: |
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Type of Business: |
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Years Acquainted: |
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Individual's Name: |
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Phone: |
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Complete Address: |
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Type of Business: |
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Years Acquainted: |
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Custom Aire, Inc. requires that its employees
be available for work throughout Minnesota and beyond as work
requires. Are you prepared to work, including overnight stays
on occasion, wherever Custom Aire, Inc. may assign you? |
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Yes
No |
If no, please explain:
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Custom Aire, Inc. requires that each employee
purchase a specified set of tools as a condition of employment.
Each individual employee is responsible for having access
to these tools each day, and the employee is responsible for
transporting his/her own tools to each project or job site.
Are you willing to purchase such tools and do you have a valid
drivers license and access to a vehicle sufficient to transport
tools to and between job sites on a daily basis? |
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Yes
No |
If no, please explain: |
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Do you plan to work for any other employer
or engage in self-employment during your period of employment
with Custom Aire, Inc.? |
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Yes
No |
If yes, please explain: |
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Are there any employer policies, requirements
or terms or conditions of employment which you are unwilling
to accept if you are offered employment? |
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Yes
No |
If yes, please explain: |
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Have you ever worked in our industry at any
time not listed above: |
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Yes
No |
If yes, give details: |
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You may be asked to provide a medical history,
submit to a drug and/or alcohol test and/or physical/medical
examination if you are made a conditional offer of employment
and must reimburse Custom Aire, Inc. for the cost if you pass,
but do not accept employment or quit within 30 days. Are you
willing to do so? |
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Yes
No |
| Custom Aire, Inc. has policies
on sexual harassment and equal employment opportunity, policies
which require employees to perform all assigned work and mandatory
overtime, policies requiring wage or salary deduction authorizations
by employees to observe all standards of conduct, policies
and work rules of Custom Aire, Inc. and for employees, non-competition
agreement requirements. Do you agree, if hired to comply with
these and all other current or subsequently adopted Custom
Aire, Inc. policies and requirements? |
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Yes
No |
If not, please explain: |
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Acknowledgment: Please Read and sign (if
you agree) |
| By my signature below, I promise that the
information provided in this employment application (and
any related information
provided by me) is true and complete, and I understand
that any false or misleading information or significant
omissions
may disqualify me from further consideration for employment,
and may lead to my dismissal from employment, if discovered
at a later date, no matter how long I have been employed.
I agree to immediately notify Custom Aire, Inc. if I should
be convicted or plead guilty to any crime while my job
application
is pending, or during my period of employment if hired
by Custom Aire, Inc..I authorize Custom Aire, Inc. (the"Employer")
to obtain and/or to provide any and all information and
opinion
which the Employer elects to obtain, use or provide in
connection with my application for employment and/or any
employment with
the Employer, prior to during and after my employment.
Such information and opinion may be sought from any and
all prior
employers (except as noted above), schools or other persons
or organizations who may have information the Employer
deems
relevant in connection with my application for employment
and during my employment, and may be provided by the Employer,
to any and all banks or mortgage companies, governmental
agencies,
insurers, prospective employers or other schools, persons
or organizations deemed appropriate for receipt of such
information
by the Employer. I understand that the Employer may provide
any and all information and opinion, which may include,
but
are not limited to, opinions about my conduct, performance,
attendance, or any other aspect of my reputation or character,
which may be positive or negative. I agree to hold the
Employer
(including its principals, employees, agents, consultants,
attorneys and insurers and any such other employer, school
person or organization providing or receiving any such
information
and opinion, harmless and free of any and all claims or
causes of action arising from and such provision or receipt
of information
and opinion, no matter what its character. I UNDERSTAND
THAT THIS APPLICATION DOES NOT CREATE A CONTRACT OF EMPLOYMENT,
I UNDERSTAND THAT, IF HIRED, I AM OBLIGED TO COMPLY WITH
ANY
AND ALL CURRENT AND SUBSEQUENTLY ADOPTED CUSTOM AIRE, INC.
POLICIES, AND THAT CUSTOM AIRE, INC. DOES NOT OFFER CONTRACTS,
PROMISES OR REPRESENTATION RELATED TO EMPLOYMENT. I UNDERSTAND
AND AGREE THAT, IF HIRED MY EMPLOYMENT IS FOR NO DEFINITE
PERIOD OF TIME, AND MAY, REGARDLESS OF THE DATE OF PAYMENT
OF WAGES OR SALARY, BE TERMINATED AT ANY TIME FOR ANY REASON,
WITH OR WITHOUT NOTICE. I UNDERSTAND THAT NO PERSON
IS AUTHORIZED TO CHANGE ANY OF THE TERMS MENTIONED IN THE
EMPLOYMENT APPLICATION. |
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Applicant's Initials: |
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Date: |
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