Job Application Form

Custom Weatherization, LLC

Application
Custom Weatherization, LLC is a quickly growing company that was started in 2006 and has been providing energy efficient services to both residential and commercial properties ever since. We provide service and expertise on the following; installation and removal of insulation, air sealing, draft testing, appliance testing, repair and installation of water heaters/solar water heaters/water heater heat pumps and much much more! We work with and are registered providers for reputable companies such as PPL, UGI, PECO and Met Ed.
Full Name *

First Name Last Name
E-mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *
EMERGENCY CONTACT *

Name Relation
EMERGENCY CONTACT ADDRESS *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
EMERGENCY CONTACT PHONE NUMBER *
Are you at least 18 years of age or older? *

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If seeking employment, may we contact your old employer? *

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Have you ever filed an application with us before? *

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Have you ever been convicted of a felony? *

Yes No
If yes, please give date and explain

Employment History Information
Work History: Current and previous 2 employers (most current employer listed first)
Employer Name
City, State
Position Held
Start Date

Month Day Year
Date Finished

Month Day Year
Employer phone
Supervisor name

First Name Last Name
Describe your duties:
Reason for leaving
NEXT EMPLOYER
Employer Name
City, State
Position Held
Start Date

Month Day Year
Date Finished

Month Day Year
Employer phone

Area Code Phone Number
Supervisor name

First Name Last Name
Describe your duties:
Reason for leaving
NEXT EMPLOYER
Employer Name

First Name Last Name
City, State
Position Held
Start date

Month Day Year
Date Finished

Month Day Year
Employer phone

Area Code Phone Number
Supervisor name

First Name Last Name
Describe your duties:
Reason for leaving

Additional Information
Driving Violations ( the past 3 years) *

Yes No
If yes, please explain

EDUCATION INFORMATION
HIGH SCHOOL
Name & City/State of High School *
Course of Study/ Degree Earned *
Did you graduate? *

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COLLEGE OR UNIVERSITY
Name & City/State of College or University
Course of Study/ Degree Earned
Did you graduate?

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OTHER
Name & City/State of OTHER (specify)
Course of Study/ Degree Earned
Did you graduate?

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You should hire me because... *
What do you know about this field? *
Why do you want to work in this field? *
Why do you think that rich people are rich, and poor people are poor? *
Resume

In completing this application, and any supplements to this application, I certify that information given herein is true and complete to the best of my knowledge. I understand that misrepresentation or omission of facts is cause for cancellation of this application or separation from the company’s service if chosen. I understand also, that I am required to abide by all rules and regulations of Custom Weatherization, LLC. I agree that Custom Weatherization, LLC shall not be liable in any respect if my association is terminated because of the falsity of statements made by me on this application. I authorize investigation of all statements contained in this application as may be necessary for arriving at a decision. I understand that information concerning my past record will be sought from my previous employers and other sources and I hereby release from all liability or damages those individuals, corporations, or organizations who provide such information. I understand that any such information provided shall become the exclusive property of the company. I understand and acknowledge that, unless otherwise defined by applicable law, any association with the company is of an ‘at will’ nature, which means that I may resign at any time and Custom Weatherization, LLC may discharge me at any time with or without cause. I further understand that this ‘at will’ relationship may not be changed unless specifically agreed to in writing by an authorized executive of this company. This certifies that this application was completed accurately and honestly by me or at my direction.
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Custom Weatherization, LLC

JOB INTEREST

Employment History Information

Additional Information

EDUCATION INFORMATION