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HVAC/R Pipefitter/Installer
Accutherm Refrigeration
Basic Information
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Certificate Obtained
HVAC/R Certificate
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General Information
Have you ever been involuntarily terminated or asked to resign from any job?
Yes
No
If yes, please explain:
Please explain any gaps in your employment history:
Please list any other experience, job related skills, certifications, or other qualifications that you believe should be considered in evaluating your qualifications for employment:
Do you have friends and/or relatives working for Accutherm?
Yes
No
If yes, name(s) and relationship(s):
On what date are you available to begin work?
Are you available to work?
Full-time
Part-time
Days available to work:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Are you able/willing to work nights?
Yes
No
If no, why not?
Minimum salary required? Per Hour or per year
If hired, would you have a reliable means of transportation to and from work?
Yes
No
Can you travel if the position requires it?
Yes
No
Are you at least 18 years old?
Yes
No
Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodation?
Yes
No
I hereby authorize Accutherm Refrigeration to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to Accutherm Refrigeration any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Accutherm Refrigeration, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
Yes
No
In the event of my employment with Accutherm Refrigeration, I understand that I am required to comply with all rules and regulations of Accutherm Refrigeration.
Yes
No
If hired, I understand and agree that my employment with Accutherm Refrigeration is at-will, and that neither I, nor Accutherm Refrigeration is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.
Yes
No
I understand that safety of employees is extremely important to Accutherm Refrigeration and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.
Yes
No
I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
Yes
No
I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.
Yes
No
I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.
Yes
No