Job Application Applicant Information Performance Insulation is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representativeApplicant Name:Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone NumberEmail Employment PositionPosition(s) applying for:How did you hear about this position?On what date can you start working if you are hired?Do you have reliable transportation to and from work?Personal InformationHave you ever applied to or worked for Performance Insulation or HomeRx before?YesNoIf yes, when?Do you have any friends, relatives, or acquaintances working for Performance Insulation or HomeRx?YesNoIf yes, state name and relationship:Are you 18 years of age or older?YesNoAre you a U.S. citizen or approved to work in the United States?YesNoWill you consent to a mandatory controlled substance test?YesNoJob SkillsPlease list below the skills and qualifications you possess for the position for which you are applying:References Please provide 3 personal and professional reference(s) below:Reference 1 Contact InformationReference 2 Contact InformationReference 3 Contact InformationEducation and TrainingHigh SchoolHigh School NameHigh School Location (City, State)High School Year GraduatedDegreeCollegeCollege NameCollege Location (City, State)Year Graduated CollegeDegreeVocational School/Specialized TrainingVocational School / Specialized TrainingVocational School Location (City, State)Year Graduated Vocational SchoolVocational School DegreePrevious EmploymentEmployer #1Employer NameJob Title:Supervisor NameEmployer Address:City, State and Zip CodeEmployer Telephone:Dates EmployedReason for leaving:Employer #2Employer Name:Job Title:Supervisor Name:Employer Address:City, State and Zip Code:Employer Telephone:Dates EmployedReason for leaving:Employer #3Employer Name:Job Title:Supervisor Name:Employer Address:City, State and Zip Code:Employer Telephone:Dates Employed:Reason for leaving:Additional InformationDo you have a valid Driver's License?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 any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in wrong 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.Applicant Signature:Date Date Format: MM slash DD slash YYYY Need HVAC Service? Contact the experts at HomeRx. Call us at 503-479-5290! Request an Estimate
