Employment Inquiry Form

Thank you for your interest in obtaining a position with Lindstrom Air Conditioning Heating and Cooling.

The following is a simple inquiry form to see if it is in your interest to take the time to come in and fill out our normal employment application and potentially interview for possible employment. All information submitted will be held in strict confidence. No phone calls will be made to your current or past employers without first talking to you. Lindstrom Air Conditioning is a drug-free workplace and will conduct a background check on all employee prospects before hiring.

Employment Inquiry Form

Position(s) Applied For:
Name * First Last
Email *
Home Phone * - (###) - ### ####
Alternative Phone - (###) - ### ####
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Social Security Number: *
Do you have a valid Driver's License? *
Drivers License Number:
NATE Certificate Number:
EPA Certificate Number:
Journeyman Card Number:
Union Card Number:
Have you filed an application here before? *
Have you ever been employed here before? *
Are you on lay off and subject to recall? *
Date Available for Work: *
What is your desired salary range? *
Will you work over time? *
How were you referred? *
Other:
List names of your friends or relatives who work here:
EDUCATION
High School Name: *
School Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Years Completed: *
Credit Recieved: *
College Name:
School Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Years Completed:
Diploma Received:
Technical or Business:
School Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Years Completed:
Diploma Received:
List knowledge, skills, abilities you posses and believe relevant to the position you seek: *
EMPLOYMENT HISTORY
Employer #1
Employer Name: *
Employer Address: *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Employed From: * / MM / DD YYYY
Employed To: * / MM / DD YYYY
Supervisor's Name/Job Title: *
May We Contact? *
Your Job Title: *
Your Starting Salary: *
Your Ending Salary: *
Duties: *
Reason For Leaving: *
Employer #2
Employer Name:
Employer Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Employed From: / MM / DD YYYY
Employed To: / MM / DD YYYY
Supervisor's Name/Job Title:
May We Contact?
Your Job Title:
Your Starting Salary:
Your Ending Salary:
Duties:
Reason For Leaving:
Employer #3
Employer Name:
Employer Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Employed From: / MM / DD YYYY
Employed To: / MM / DD YYYY
Supervisor's Name/Job Title:
May We Contact?
Your Job Title:
Your Starting Salary:
Your Ending Salary:
Duties:
Reason For Leaving:
If unemployed at any time, please describe reasons for unemployment:
Have you ever been discharged or forced to resign for misconduct or unsatisfactory performance? *

NOTE: A "YES" answer to these questions will not automatically bar you from employment. We will consider the nature, job-relatedness, severity and date of the offense.
If yes, please give details:
VEHICLE INFORMATION
Within the past 12 months, how many traffic citations have you received? *
Explain date and result of each:
Have you ever been convicted or plead no contest to operating a motor vehicle while under the influence of alcohol or illegal substances? *

NOTE: A "YES" answer to these questions will not automatically bar you from employment. We will consider the nature, job-relatedness, severity and date of the offense.
If yes, what was the charges?
Where Convicted?
Date of Conviction: / MM / DD YYYY
BACKGROUND INFORMATION
Have you ever been convicted of a felony or a first degree misdemeanor? *

NOTE: A "YES" answer to these questions will not automatically bar you from employment. We will consider the nature, job-relatedness, severity and date of the offense.
If yes, what was the charges?
Where Convicted?
Date of Conviction: / MM / DD YYYY
Have you ever had the adjudication of guilt withheld for a crime which is a felony or a first degree misdemeanor? *

NOTE: A "YES" answer to these questions will not automatically bar you from employment. We will consider the nature, job-relatedness, severity and date of the offense.
If yes, what was the charges?
Where Convicted?
Date of Conviction: / MM / DD YYYY
Have you ever plead no contest for a crime which is a felony or a first degree misdemeanor? *

NOTE: A "YES" answer to these questions will not automatically bar you from employment. We will consider the nature, job-relatedness, severity and date of the offense.
If yes, what was the charges?
Where Convicted?
Date of Conviction: / MM / DD YYYY
Are you currently involved in any claim, dispute or litigation which might require absence from work? *
The state of Florida hires only U.S. citizens and lawfully authorized alien workers. If a conditional offer of employment is made, you will be required to provide identification and proof of citizenship or authorization to work in the U.S. Are you a U.S. citizen or are you legally authorized to work in the U.S.? *
I am aware that any omissions, falsifications, misstatements or misrepresentations above may disqualify me for employment consideration, and if I am hired, may be grounds for determinations at a later date. I understand that any information I give may be investigated as allowed by law. I consent to the release of information about my ability, employment history and fitness for employment by employers, schools. law enforcement agencies. I certify that to the best of my knowledge and behalf all of the statements contained herein and on any attachments are true, correct and made in good faith.
Name First Last
Date / MM / DD YYYY
Do you want to join our mailing list?

Share |

QUICK CUSTOMER TOOLS

Click here to join our newsletter!

QUICK CONTACT INFO

Telephone
(954) 420-5300 - Main
(888) 824 1800 - Toll Free

FAX
(954) 420-0033

Employment Inquiry Form

Employment Inquiry Form