Application for Employment for Design Comfort Inc.
Personal Information

First Name: Last Name: Middle Intial:
Social Security Number:
Present Address
Street: City: State: ZIP:
Permanent Address
Street: City: State: ZIP:
E-mail:

Are you 18? Yes | No
Phone Apartment #
In case of Emergency Notify
Name:
Address:
Phone:
Are you Prevented from lawfully becoming employed in this country because of VISA or immigration status? Yes No

Employment Desired
Position: Date you can start:
Salary Desired:
Are you employed now? Yes No
If so may be inquire of your present employer? Yes No
Ever applied to this company before? Yes No
Where? When?
Ever worked for this company before? Yes No
Where? When?
Reason for Leaving

Name of last supervisor at this company:
Who referred you to this company?
Employment Agency
Newspaper Advertisement
State Employment Office
College Placement Service
Walked in
Friend
Other
Education
School Level Name and Location of School No. of Years Attended Did you Graduate? Subjects Studied
Grammar School Yes No
High School Yes No
College Yes No
Trade School Yes No
General
Subjects of special study or research work?

Special Training

Special Skills
Former Employers (List below last three employers, starting with last one first.)
Present or last employer:
Name: 
Address:


Starting Date: Year Month   Leaving Date: Year Month

Weekly Starting Salary:   Weekly Final Salary:

Job Title:   May we contact your supervisor? Yes  No

Name and Title of Supervisor:  Phone:

Description of work:


Reason for Leaving:

Present or last employer:
Name: 
Address:


Starting Date: Year Month   Leaving Date: Year Month

Weekly Starting Salary:   Weekly Final Salary:

Job Title:   May we contact your supervisor? Yes  No

Name and Title of Supervisor:   Phone:

Description of work:


Reason for Leaving:

Present or last employer:
Name: 
Address:


Starting Date: Year Month   Leaving Date: Year Month

Weekly Starting Salary:   Weekly Final Salary:

Job Title:   May we contact your supervisor? Yes  No

Name and Title of Supervisor:  Phone:

Description of work:


Reason for Leaving:
References: Give below the names of three persons not related to you, whom you have known at least one year.
Name Address Business Years Acquainted
1.
2.
3.
Service Record
Branch of Service Discharge Date Rank
Present Membership in National Guard or Reserves Date Obligation ends
Additional Information Service Department Applicants Only
Rate yourself: Electrical knowledge Poor: Fair: Good: Exc.:
Heating Equipment Electrical knowledge Poor: Fair: Good: Exc.:
Refrigeration Equip. Poor: Fair: Good: Exc.:
Have you worked on? If so What tonnage?
Chillers Yes: No:
Heaters Yes: No:
A/C Units Yes: No:
Air Driers Yes: No:
Exhaust Fans Yes: No:
Boilers Yes: No:
Control Panel Yes: No:
Air Make-up Units Yes: No:
Dust Collection Yes: No:

"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at anytime, at either my or the company option. I also understand and agree that the terms and condition of my employment may be changed, with or without cause and without or without notice, at any time by the company. I understand that no company representative, other than its president, and only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or make any agreement contrary to the foregoing."


By checking this box I signify that I agree with the above statement.