Coomes Air Conditioning & Heating

*First Name:

Middle Initial:

*Last Name:

Address

*Address:

*City:

*State/Province:

*Postal Code:

*Home Phone Number:

Personal Cell Phone Number:

*Email address:

*Confirm email address:

Do you have a valid Driver's License?

Yes

*Type of Work Desired:

*Days / Hours Available:

Have you applied with us before?:

If Yes, When?:

Education & Certifications

High School

Number of years attended:

Did you Graduate?

Yes

Name and Location of School:

Subjects Studied:

College

Number of years attended:

Did you Graduate?

Yes

Name and Location of School:

Subjects Studied:

Trade or Business School

Number of years attended:

Did you Graduate?

Yes

Name and Location of School:

Subjects Studied:

Current Certifications and Licenses:

Have you ever been convicted of a felony?

If yes, please provide details:

Employment History

Company Name:

Start Date:

End Date:

Starting pay rate:

Starting pay type

Hourly

Monthly

Annually

Ending pay rate:

Ending pay type

Hourly

Monthly

Annually

Duties:

Reason for Leaving:

Name of Supervisor:

Supervisor's Title:

Supervisor's Phone Number or Reason not to contact:

Company Name:

Start Date:

End Date:

Starting pay rate:

Starting pay type

Hourly

Monthly

Annually

Ending pay rate:

Ending pay type

Hourly

Monthly

Annually

Duties:

Reason for Leaving:

Name of Supervisor:

Supervisor's Title:

Supervisor's Phone Number or Reason not to contact:

Company Name:

Start Date:

End Date:

Starting pay rate:

Starting pay type

Hourly

Monthly

Annually

Ending pay rate:

Ending pay type

Hourly

Monthly

Annually

Duties:

Reason for Leaving:

Name of Supervisor:

Supervisor's Title:

Supervisor's Phone Number or Reason not to contact:

References

Reference 1 Name:

Reference 1 Phone Number:

Reference 2 Name:

Reference 2 Phone Number:

Reference 3 Name:

Reference 3 Phone Number:

Additional Skills

Other Skills:

Special Training:

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