CVA Employment Application Form

ADDITIONAL INFORMATION
Have you ever been asked to resign from a position of employment or been dismissed, fired, discharged, suspended, or otherwise subject to disciplinary action?*

YesNo
Do you have any type of job specific certifications?*

YesNo
Do you hold any type of job specific professional license or membership? *

YesNo
If your answer to any of the above questions is yes, please explain.*

WORK EXPERIENCE
Employer*
Date*

MonthDayYear
Address*

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title*
Phone Number*
Duties*
Reason for Living*
WORK EXPERIENCE - 2
Employer
Date

MonthDayYear
Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Phone Number
Duties
Reason for Living

EDUCATION

Level of Education*

	Name of school or University	State	Field of Study	Type of Degree	Dates of Attendance (From - To)
High School
College
Others
Others

REFERENCES

References*

	Name	Position	Business	Years Known	Phone
1
2
3
4

APPLICANT’S STATEMENT

(Initial each statement as read)
- * The information that I have provided on this application is accurate to the best of my knowledge and may be verified by the company or its agents.
- * In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
- * This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether applications are being accepted at that time.
- * I understand that Conejo Valley Heating & Air Conditioning, Inc. (CVHA) is committed to maintaining a drug and alcohol-free workplace. Accordingly, I may be subject to a pre-employment drug/alcohol screening. I further understand that if employed, I may be subject to such a drug and alcohol screening if CVHA has reasonable suspicion to believe that I am under the influence of a drug or alcohol and if after a work accident. My consent to submit to such a test is required as a condition of employment and my refusal to consent shall result in a refusal to hire or, it if already employed, termination.
- * I understand and agree that the employment for which I am making application is, and is intern to be, at-will and such employment may be terminated at any time with or without cause, without prior notice, by either myself or Conejo Valley Heating & Air Conditioning There will be no agreement, express or implied between Conejo Valley Heating & Air Conditioning and me for any specific period of employment, nor for continuing or long term employment, unless made in writing, signed by an authorized executive of this organization.
- * It is Conejo Valley Heating and Air Conditioning, Inc. policy that all offers are subject to criminal and background checks,
I have placed my signature in the space provided below only after I have completed the entire application to the best of my ability and have carefully read the statements listed above.
Name*
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

EMPLOYMENT APPLICATION

PERSONAL INFORMATION

ADDITIONAL INFORMATION

WORK EXPERIENCE

WORK EXPERIENCE - 2

EDUCATION

REFERENCES

APPLICANT’S STATEMENT