Application for Employment

Application Process Information

Where are you filling out this application?

Personal Information

Social Security Number:
Present Address
Home Number:
Mobile Number:
Email Address:
If necessary, can you provide proof that you
are over any minimum work age requirement?

We Are An Equal Opportunity Employer

Applications are received and employees are hired without regard to race, creed, color, sex, religion, age, national origin, marital status, physical or mental handicap, disability, sexual orientation, veteran's status, citizenship status, or any other protected classes under state, local or county regulations. The receipt of this application does not mean that job openings exist and does not obligate us in any way. We appreciate your interest in Bell Cow HVAC.

This is a drug-free workplace

Employment Desired

Date You Can Start:
Salary Desired:
Willing to work overtime?
Willing to work Saturdays?
Were you referred by an employee?
Referring Employee Name
How were you referred to us?
Have you been employed here before?
   If yes, date/position/location?
Are you on a layoff and subject to recall?
How much time have you lost from
work during the past 12 months?
Are you currently subject to a Non-Compete Agreement or
Restrictive Covenant that would prohibit you from working
at Bell Cow HVAC in the position for which you are applying?


Name and location of school Last Year Completed Did You Graduate? Subjects Studies and Degree(s)
High School
Trade, Business or Correspondence School

Skills and Qualifications

List any professional, trade, business, or civic activities
or offices held that would relate to working here
List any special skills, training, experience, certifications, or
licenses that may be relevant to this position or our company
Drivers License Number:
Drivers License State:
Birth Date:
Do we have your permission to check with the State on your driving record?

Former Employers

List below your last four employers, starting with the last one first.
Starting Date
(Mo. and Yr.)
Ending Date
(Mo. and Yr.)
Name and Address of Employer Contact Phone Salary
(upon leaving)
Position Reason for leaving


List below three persons not related to you, whom you have known at least one year.
Name Address Phone Position Years Acquainted

Work Duties

Please see the specific job description for the position you are applying.


Have you been in the military?
   Branch of service:
   Rank at discharge, if applicable:
Do you have an annual commitment to attend reserve duty or national guard encampment annually?
Do you have any history of past motor vehicle accidents?
   If yes, explain:
Have you ever been refused Bond by a bonding and/or insurance carrier?
   If yes, state employer you were working for and date:
Have you ever been disciplined or terminated from any job for an act of violence, harassment, discrimination, ethical breach or theft?
   If yes, explain the circumstances, employer, and date:
Are you currently wanted by any law enforcement agency or do you currently have any criminal charges pending against you?
   If yes, by what agency and for what act?
Have you ever been convicted of; received a sentence for; pled nolo contendere (no contest) to; been placed on probation, fined, or entered a pretrial intervention program for; or had adjudication withheld by any judicial or quasi-judicial body for a crime, other than a minor traffic violation? (Any criminal record not disclosed by you may be considered falsification of this application, which may result in revocation of your employment offer or termination of your employment. Also, in accordance with any state or federal regulations, you may be required to provide copies of any criminal records. Answering "yes" to this question in not an automatic bar to employment.)

   If yes, describe the details of the conviction or other disposition of the charge,
   the date of the offense (month and year), your age at the time of the offense, and your rehabilitation
   since the conviction and/or disposition of the offense.

Agreement and Release

For the purpose of this agreement and release, the organization that has provided you with this application is referred to as "the company", "this company", or "you". The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application (even if discovered after employment) or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history. financial, criminal, credit, and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer a personality profile or other pre-employment tests and verify my background. A criminal record or sentence is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment, and I agree to submit to a medical evaluation, if required. I consent to the release of any or all medical information or records deemed necessary to determine my capability to perform the essential job functions of the position for which I may hold.

In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. In exchange for the consideration of my employment application by this company, I hereby release and forever discharge this company (including its directors, officers, employees, and agents) and my past and/or present employers (including their directors, officers, employees, and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize the use of any information in this application to verify my statements, and I authorize past employers, doctors, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record.

I understand that if my application is accepted that employment with this company at all times is employment "at will". It is further understood that this "at will" relationship may not be changed by any written document, verbal statements, or by conduct unless an authorized executive of this company specifically acknowledges such change. I further understand that my "at will" employment may be terminated at any time by this company or myself and includes no guarantee, contract, or promise of employment for any specific length of time. I understand that the first 90 days of employment is a new-hire introductory period.

I have read, understand, and by my signature consent to these statements.

I accept the above agreement

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