We appreciate the opportunity to review your qualifications for employment with the company. So that we can
thoroughly consider your special skills and abilities, we would appreciate your completion of our Employment
Application. This employment application will only be valid for 30 days from the date of the application. If
you wish to be considered for employment subsequent to that date, a new application must be completed.
Thank You
Applicant Name:
Email Address:
(PLEASE PRINT AND COMPLETELY ANSWER ALL QUESTIONS)
Custom Air Products & Services, Inc. and its Clients fully subscribe to the principles of Equal Employment
Opportunity. It is our policy to provide employment, compensation, and other benefits related to employment
based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status,
disability, or any other basis prohibited by federal, state or local law. In accordance with requirements of
the Americans With Disabilities Act, it is our policy to provide reasonable accommodation upon request during
the application process to eligible applicants in order that they may be given a full and fair opportunity to
be considered for employment. As Equal Opportunity Employers, we intend to comply fully with applicable
federal and State employment laws and the information requested on this application will only be used for
purposes consistent with those laws. Applications are only accepted for positions currently available and
will only be considered for thirty (30) days from today's date or until the position applied for is filled,
whichever first occurs.
Position Applied For:
Date:
Personal Data
If you are under 18 years of age, please specify your age here:
This information will be used only for child labor law purposes.
Are there any days, shifts or hours you will not work? YES:
NO:
lf yes, please explain:
Are you available for out of town work? YES:
NO:
Will you work overtime, if required? YES:
NO:
When will you be able to start work?
Have you taken any illegal drugs in the last 30 days? YES:
NO:
Have you ever been a defendant in a civil action for an intentional commission of a wrongful act? YES:
NO:
Note:
Answering "yes" does not automatically exclude you from further consideration for the position.
If yes, include nature of the intentional tort and the disposition of the action:
How did you learn of our Company?
If referral, whom where you referred by?
Have you ever applied or worked at Custom Air Products & Services, Inc. before? YES:
NO:
If yes, provide dates:
Are you legally authorized to work in the United States? YES:
NO:
Will you now or in the future require sponsorship for employment visa status (e.g.,H-1 B visa status)? YES:
NO:
Note:
The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification "Form
1-9" be completed for every new hire and that within 3 business days of beginning work every new hire must present to the
employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a
condition of employment.
DRIVING RECORD
(Answer only if driving is a requirement of the job for which you are applying)
Do you have a valid drivers license? YES:
NO:
State:
Have you had any tickets? YES:
NO:
If yes, please explain:
Has your license ever been suspended or revoked? YES:
NO:
If yes, please explain:
Do you have any DUI or DWI convictions? YES:
NO:
If yes, please state when you were convicted and explain:
RESIDENCES:
(Please provide your addresses of residence for the past seven years beginning with the most recent address.)
EDUCATION:
(May or may not be considered depending on job applied for.)
Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for:
EMPLOYMENT HISTORY:
Please complete for all full-time or part-time employment beginning with most recent employer.
You may include as part of your employment history any verified work performed on a volunteer basis.
REFERENCES:
(Please list three persons not related to you who know your qualifications.)
MILITARY SERVICE:
(Complete only if you served in the military)
Branch of Service:
Number of Years/Months of Service:
Rank at Discharge:
Date of Discharge:
Reason for leaving:
Describe any military skills, training or experience you believe are relevant to the job applied for:
CRIMINAL RECORD INFORMATION:
All Applicants: You must answer all four questions below. When answering the following questions, you
may exclude any records expunged, annulled, sealed, discharged, dismissed, erased under first-offender law or
otherwise eradicated by statute or court order. You may also exclude a first conviction for any of the following
misdemeanors; drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace.
A criminal conviction will not necessarily be a bar to employment but will be considered in relation to specific job requirements.
1. Have you been convicted of a felony within the last seven years?
YES:
NO:
Date of Conviction:
2. Have you been convicted within the last seven years of misappropriation of funds, embezzlement, or similar for other
dishonest conduct; or an offense involving the use of a weapon; for burglary, robbery, breaking and entering or theft; or
physical assault or other violent crime?
YES:
NO:
3. Have you been convicted of or completed a period of incarceration within the past five years for any misdemeanor?
YES:
NO:
If the answer to the above question is "yes", please state whether you were convicted more than five years ago for any offense?
4. A criminal conviction will not necessarily be a bar to employment. To help us evaluate your application, please describe
your criminal conviction(s) including penalty (ies) imposed, listing the nature of your offense(s), and your rehabilitation
since the conviction(s).
APPLICANT'S ACKNOWLEDGMENT
I certify that the answers given herein are true and complete to the best of my knowledge. I understand that any misrepresentations,
omissions of facts or incomplete answers in any application document may disqualify me from further consideration
for employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application
document may be cause for my dismissal at any time without prior notice. I consent to and authorize Custom Air Products &
Services, Inc. to contact my former employers, references, and any and all other persons and organizations for information
bearing upon my qualifications for employment. I further authorize the listed employers, schools and personal references
to give Custom Air Products & Services, Inc. (without further notice to me) any and all information about my previous employment
and education, along with any other pertinent information they may have and hereby waive any actions which I may
have against either party(ies) for providing a good faith reference.
I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MYEMPLOYMENT IS NOT FOR A SPECIFIC TERM, IS
BASED ON MUTUAL CONSENT AND MAYBE TERMINATED BY MEOR MYEMPLOYER(S) WITH ORWITHOUT NOTICE
ORCAUSE AT ANYTIME. I FURTHER UNDERSTAND THATNO ORAL PROMISE, EMPLOYER(S) POLICY, CUSTOM, BUSINESS
PRACTICE OROTHER PROCEDURE (INCLUDING THEBASIC EMPLOYMENT POLICIES, PERSONNEL HANDBOOK
ORANY PERSONNEL MANUALS) CONSTITUTE AN EMPLOYMENT CONTRACT OR MODIFICATION OF THEAT-WILL
EMPLOYMENT RELATIONSHIP BETWEEN MEAND THE EMPLOYER(S). I ALSO UNDERSTAND THATTHIS ASPECT OF MY
EMPLOYMENT MAYNOT CHANGE ABSENT AN INDIVIDUAL WRITTEN AGREEMENT SIGNED BYBOTH MEAND THE
PRESIDENT OF CUSTOM AIRPRODUCTS & SERVICES, INC..
I understand that applicants for certain positions may be required to qualify for employment based on additional employment
criteria. For example, I may be required to take job-related tests; take a driver's examination; submit to a background
investigation; take a pre-employment drug test. If I am offered employment or start work before any required test is completed,
my employment is contingent on a satisfactory result on all required tests. I authorize Custom Air Products & Services, Inc.
and its clients to release the results of background checks (if any) and my pre-employment drug/alcohol test (if any), any
information on this application and any relevant information about me to each other and to other Custom Air Products & Services,
Inc. clients for whom I have applied for employment, and release Custom Air Products & Services, Inc. and its clients from any and
all claims related to the lawful release of this information. I further authorize the release of any background check results of
any drug/alcohol test to any state or federal authority requesting such information and in response to a valid subpoena or
other legal document.
By Submitting this application I acknowledge that this application will remain active for 30 days from this date. If I have not
heard from the Company at the conclusion of this 30 day period, it is my responsibility to complete a new application if I still
wish to be considered for employment.
Verification:
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Custom Air Products & Services, Inc.