Careers | Gagne Heating & Air Conditioning

Applicant Information
Position(s) Applied For*
Date
MM slash DD slash YYYY
Name*
First Middle Last
Address*
Street Address City State ZIP Code
Phone*
Other Phone
Email*
Are you under the age of 18?*
- Yes
- No
Note: If yes, you may be required to furnish proof of exemption or partial waiver as detailed by your State Child Labor Law.

Have you previously filed an application with this company?*
- Yes
- No
If yes, what date?
MM slash DD slash YYYY
Have you previously been employed by this company?*
- Yes
- No
If yes, what date?
MM slash DD slash YYYY
Please list any relatives or friends who are employed at this work site and their relationship to you.
Do you have the legal right to work in the United States?*
- Yes
- No
Note: You will be required to provide appropriate document(s) for completion of the I-9 at the time of employment.

Skills and Qualifications
Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job related functions in the position for which you are applying*
Other Languages (Please indicate if read, written, or spoken)
Driver’s License (only complete if required for position)
Do you have a valid driver’s license?*
- Yes
- No
If yes, answer the following:
Driver’s License #
Class
State Issued
Expiration Date
MM slash DD slash YYYY

Personal References
Please provide two individuals, not relatives, whom you have known at least 1 year.
Reference 1
Name*
Phone*
Years Known*
Address*
Reference 2
Name*
Phone*
Years Known*
Address*

Employment Experience
List all your previous employers (most recent first). Account for all time periods including unemployment, self-employment and military service. This section must be completed in full in addition to any attached resume.
Employer 1
Employer
Address
Date Hired
Date Left
Supervisor
Phone
Starting Salary
Final Salary
Job Title
Work Performed
Reason for leaving
Employer 2
Employer
Address
Date Hired
Date Left
Supervisor
Phone
Starting Salary
Final Salary
Job Title
Work Performed
Reason for leaving
Employer 3
Employer
Address
Date Hired
Date Left
Supervisor
Phone
Starting Salary
Final Salary
Job Title
Work Performed
Reason for leaving
Please provide consent*
I agree to all rules and regulations of the Company.*