Application
Simply fill out the application below.

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.

Positions Applied For:

Date of Application:

Name:

First:

Middle:

Last:

Current Date:

Have you ever been known by another name or by an alias:

If yes, what:

Present Address:

Permanent Address:

Social Security No.

Home Phone No.

Other phone at which you can be reached (present work # if employed)

If hired, can you furnish proof that you are 18 years of age, or older?

If hired, can you furnish proof that you are eligible to work in the United States?

Have you applied for work or worked at our Company before?

Are you available to work at any time of the day or week as needed?

If not, please explain limitations:

Date You Can Start:

Desired Wage or Salary:

Have you ever been convicted of a crime? (minor traffic violations may be omitted.)

If yes, provide the date, location and circumstances and identify the offense(s) and jurisdictions(s):

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)?

Have you received DWI, DUI or other driving violations within the last two years?

If yes, please explain:

Please provide education information if you wish to be considered now or in the future for a supervisory or office position:

Have you served in the Military?

If Yes, which Branch and rank and nature of discharge?

Briefly describe any military duties related to position applied for:

Present Membership in National Guard or Reserves?

Have you ever worked in a position similar to the one for which you are applying?

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:

Where have you gained this experience?

Are you acquainted with anyone who is or was employed by our Company?

If yes, who, and how do you know them?

Work History -- List all employers during last ten years, with present or last employer first.

Employer

Name:

Address

Telephone:

Position:

Duties:

Final Pay Rate:

Supervisor's Name & Title:

Dates of Employment

Reason for leaving:

Employer 2

Name:

Address:

Telephone:

Position:

Duties:

Final Pay Rate:

Supervisor's Name & Title:

Dates of Employment

Reason for leaving:

Employer 3

Name:

Address:

Telephone:

Position:

Duties:

Final Pay Rate:

Supervisor's Name & Title:

Dates of Employment

Reason for leaving:

Employer 4

Name:

Address:

Telephone:

Position:

Duties:

Final Pay Rate:

Supervisor's Name & Title:

Dates of Employment

Reason for leaving:

List all periods of unemployment since you finished school.

How did you spend this time?

Have you ever been fired, laid off or asked to resign by an employer?

If yes, please explain:

May we contact the employers listed above?

If no, please explain:

Are you on layoff status and eligible for recall or eligible for referral for hire by a hiring hall or employment service?

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:

Phone:

Complete Address:

Type of Business:

Years Acquainted:

Individual's Name:

Phone:

Complete Address:

Type of Business:

Years Acquainted:

Individual's Name:

Phone:

Complete Address:

Type of Business:

Years Acquainted:

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?

Yes
No

If no, please explain:

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?

Yes
No

If no, please explain:

Do you plan to work for any other employer or engage in self-employment during your period of employment with Custom Aire, Inc.?

Yes
No

If yes, please explain:

Are there any employer policies, requirements or terms or conditions of employment which you are unwilling to accept if you are offered employment?

Yes
No

If yes, please explain:

Have you ever worked in our industry at any time not listed above:

Yes
No

If yes, give details:

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?

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?

Yes
No

If not, please explain:

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.

Applicant's Initials:

Date: