Pacific International Cooling

Pacific International Cooling
EMPLOYMENT APPLICATION

APPLICANT INFORMATION
Name*

First NameLast Name
Middle Initial
Date of Birth*

MonthDayYear
Date
SSN
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Message Number
If you're not available.
Email
example@example.com
Are you 18 or older?
Entitled to work in the U.S.
Military service?
If yes, which branch?
Convicted of a felony?
If yes, please explain
What position are you applying for?
Expected Hourly Rate
Will you work overtime if asked?
Date available to begin.

MonthDayYear
Date
Do you have any friends or relatives working for Pacific
Possess a valid driver license.
How do you feel about working evenings or holidays.
Today's Date

MonthDayYear
Date

PREVIOUS EXPERIENCE (FIRST EMPLOYER)
Employer Name 1*
Supervisor Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position Held
Reason for leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Rate of Pay
May we contact?

PREVIOUS EXPERIENCE (SECOND EMPLOYER)
Employer Name 2*
Supervisor Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position Held
Reason for leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Rate of Pay
May we contact?

PREVIOUS EXPERIENCE (THIRD EMPLOYER)
Employer Name 3
Supervisor Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position Held
Reason for leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Rate of Pay
May we contact?

REFERENCES (First person)
Name
Address
Phone Number
Please enter a valid phone number.
Years Known
Relation

REFERENCES (Second person)
Name
Address
Phone Number
Please enter a valid phone number.
Years Known
Relation

REFERENCES (Third person)
Name
Address
Phone Number
Please enter a valid phone number.
Years Known
Relation

EDUCATION
HIGHSCHOOL
Name and location
Last year completed:
Major / Emphasis & Degree Earned
COLLEGE / UNIVERSITY
Name and location
Last year completed:
Major / Emphasis & Degree Earned
TRADE SCHOOL
Name and location
Major / Emphasis & Degree Earned
Applicable Skills / Proficiencies
Other / Applicable Training

END
I understand that Pacific International/Pure Pacific Cooling are committed to maintaining an alcohol/ drug free workplace and requires a drug screening test as a part of its selections and hiring practices. I understand that such drug screening will consist of the testing of a urine sample or a medical recognized test designed to detect traceable amounts of a controlled substance in my body. If it is determined my specimen contains a controlled substance or was adulterated or substituted, I will be disqualified from consideration for employment and any offer will be withdrawn I understand and agree that if I am employed I may be required to submit to alcohol drug testing under certain circumstances during my employment I have read, understand and agree to this statement.
Initials
I authorize investigation of statements contained in this application. I understand that misrepresentation or commission of facts called for it cause for dismissal, Further, I understand and agree that employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without previous notice. Furthermore, I authorize and agree to a pre-employment drug screening test, which the company may ask me to take prior to my employment with the company.
Initials
I certify that the information on this application is correct and understand that any misrepresentation or omission of any information will result in my disqualification from considering for employment or if employed, my dismissal. I understand that this application is not a contract. offer or promise of employment and that if hired, I will be able to resign at any time for any reason Likewise, the company can terminate my employment at any time with or without cause, unless otherwise required by law. I have read, understand and agree to this statement
Initials
SIGNATURE

Clear
DATE

MonthDayYear
Date
Should be Empty:

Pacific International Cooling

EMPLOYMENT APPLICATION

HIGHSCHOOL

COLLEGE / UNIVERSITY

TRADE SCHOOL