Join Our Team | Careers at Keith Air Conditioning

First Name

Middle Name

Last Name

Address

ZIP Code

Phone

Social Security Number

Type of work desired

Wages expected

If under 18 years of age, do you have a work permit?

Yes

Are you either a U.S. citizens or legally authorized to work in the United States?

*You will be required to provide proof of citizenship or right to work status at time of hire.

Are you either a U.S. citizens or legally authorized to work in the United States?

Yes

Have you been convicted of a crime?

Yes

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Education

Select the Highest Grade Completed for Grade School/High School:

Select the Highest Grade Completed for College/Graduate School

School Name

Location

Degree

Dates Attended:

School Name

Location

Degree

Dates Attended:

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Professional Licenses and/or Certifications

Type

Organization/or State Issued

Date Issued:

Number

Type

Organization/or State Issued

Date Issued:

Number

Type

Organization/or State Issued

Date Issued:

Number

Previous Work Experience

Previous Work Experience

Present or last employer

Phone

Address

Position/Duties

Salary

Dates of Employment

Reasoning for Leaving

Present or last employer

Phone

Address

Position/Duties

Salary

Dates of Employment

Reasoning for Leaving

Present or last employer

Phone

Address

Position/Duties

Salary

Dates of Employment

Reasoning for Leaving

Physical and Medical Information

Physical and Medical Information

In responding to the following question, please refer to the attached job description for the position for which you are seeking employment.

Do you have any physical or mental condition which would substantially interfere with your ability to perform the essential duties of the job for which you have applied for which you will need reasonable accommodation?

Yes

Name, address, and phone number of physician having records and/or knowledge of your medical history:

Name

Address

Phone

May we contact your physician on your medical history?

Yes

Will you authorize if necessary, a release of your medical records to assist us in determining your fitness to perform any physical activities related to the job you are applying for?

Yes

*The responses to these questions will not be taken into consideration until after a conditional job offer has been made.

Personal References:

Personal References:

(Do not list relatives or former employers)

Name

Address

Phone

Name

Address

Phone

Name

Address

Phone

Applicant Certification

Applicant Certification

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I certify that all information given on this application is true, correct, and complete. I understand that misrepresentation or omission of facts will cause for cancellation of my consideration for employment, or dismissal if employed. I authorize any inquiry to be made on any information contained in the application if I am considered for employment. I understand that this is an application for employment and that no employment contract is being offered, and I understand that if employed, such employment is for an indefinite period and is subject to change in wages, benefits, and operating policies. I further understand that an offer of employment will be conditioned upon the completion of a physical examination including a drug test that continued employment will be subject to terms of Keith Air Conditioning, Inc. Drug and Alcohol policy.

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