Elkhorn Heating & Air Conditioning, Inc.

Residential & Commercial

Heating • Air Conditioning • Ventilation • Refrigeration • Ice Machines • Sheet Metal

Serving the Denver, Colorado Metro area

Office: 303-975-8809
3065 S. Umatilla St.
Englewood, CO 80110
info@ ElkHVAC.com

Application for Employment

An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation.

It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

Answer each question fully and accurately.
No action can be taken on this application until you have answered all questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Tuesday September 7th, 2010
Job Applied for:
First Name: Middle Name: Last Name:
Present Street Address:
City: State: Zip Code:
Primary Telephone Number:
Alternate Telephone Number:
Email Address:
Are you seeking: Full-time Part-time Temporary employment?
When could you start work?
Are you 18 years of age or older? .................................................................................................. Yes No
(If you are hired, you may be required to submit proof of age.)
If hired, can you furnish proof you are eligible to work in the U.S.? ............................................ Yes No
Have you ever applied here before? ............................................................................................... Yes No
Were you ever employed here? ...................................................................................................... Yes No
Have you ever been convicted of any law violation? ..................................................................... Yes No
Include any plea of "guilty" or "no contest". (Exclude minor traffic violations.)
(A conviction will not necessarily disqualify an applicant for employment.)
If employed, do you expect to be engaged in any
additional business or employment outside of our job? ................................................................. Yes No
Do you have a valid drivers license? ............................................................................................... Yes No
Have you had your driver's license suspended or revoked in the past three (3) years? ............. Yes No
List professional, trade, business or civic activities and offices held.
(Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.)
List Name and Address of Schools
High School or GED
Name: Address:
Numbers of Years Completed: Diploma/Degree/Certificate:
Subjects Studied:
College or University
Name: Address:
Numbers of Years Completed: Diploma/Degree/Certificate:
Subjects Studied:
Vocational or Technical
Name: Address:
Numbers of Years Completed: Diploma/Degree/Certificate:
Subjects Studied:
What skills or additional training do you have that relate to the job for which you are applying?
What machines or equipment can you operate that relate to the job for which you are applying?
List names of employers in consecutive order with present or last employer listed first.

Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references.

Note: A job offer may be contingent upon acceptable references from current and former employers.
Name of Employer:
Address: City: State: Zip Code:
Supervisor(s): Phone Number:
Job Title: Duties:
Dates of Employment: (Mo/Yr) From: To: Pay: Starting: $ Final: $
Reason for leaving:
Have you worked or attended school under any other names? ................................................. Yes No
Are you presently employed? ...................................................................................................... Yes No
Have you ever been fired from a job or asked to resign? .......................................................... Yes No
Give three (3) references, not relatives or former employers.
Name: Phone:
Address: City: State: Zip Code:
Name: Phone:
Address: City: State: Zip Code:
Name: Phone:
Address: City: State: Zip Code:
Use this space to provide any additional information.
Please Read Each Statement Carefully

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required.

I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I understand that this application, verbal statements by management, or subsequent employment does not create an express or implied contract of employment nor guarantee employment for any definite period of time. Only the president of the organization has the authority to enter into an agreement of employment for any specified period and such agreement must be in writing, signed by the president and the employee. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without reason and with or without notice.

I have read, understand, and by checking this box consent to these statements.