Application – Chey Insulation

Application

Job Application

Applicant Information

It is the policy of Chey Insulation, Inc. to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability, or veteran status.

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Number of years at this address:

Daytime Phone

Evening Phone

Mobile Phone

The Position

Which position are you applying for?

What is your desired salary

Is that…

per hour

per month

per year

Have you applied to our company perviously?

Yes

When did you previously apply?

Did anyone refer you to our company? If, so who?

Do you have any friends or relatives who work here? If yes, please provide their names

Please provide answers to the following:

	Yes	No
Do you have a Driver’s License?
Are you at lease 18 years old?
If applicable, are you able to work overtime?
If hired, are you able to submit proof that you are legally eligible to work in the United States?
Are you able to perform the essential functions of the job position you are applying for with or without reasonable accomodation?

What reasonable accomodation, if any, would you request?

Applicant Skillset

List any skills that may be useful for the job you are seeking. Enter the number of years of experience and choose the level that corresponds to your ability for each particular skill. (One represents poor ability, while 5 represents exceptional ability)

Skill

Skill

Years of Experience

Years of Experience

Rating (1 to 5)

Rating

Skill

Years of Experience

Rating

Skill

Years of Experience

Rating

Skill

Years of Experience

Rating

Skill

Years of Experience

Rating

Skill

Years of Experience

Rating

Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment.

Employer #1

Employer Name

Supervisor Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Job Duties

Reason for Leaving

Start Date

Last Date

Employer #2

Employer Name

Supervisor Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Job Duties

Reason for Leaving

Start Date

Last Date

Employer #3

Some description about this section

Employer Name

Supervisor Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Job Duties

Reason for Leaving

Start Date

Last Date

Add More?

Employer #4

Employer Name

Supervisor Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Job Duties

Reason for Leaving

Start Date

Last Date

Add More?

Employer #5

Employer Name

Supervisor Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Job Duties

Start Date

Last Date

Reason for Leaving

Add Another?

Employer #6

Employer Name

Supervisor Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Job Duties

Reason for Leaving

Start Date

Last Date

Any other awards, honors or special achievements?

Do you have a resume you’d like to upload?

If so you can upload a PDF version of the resume below

Upload Your Resume

Choose File

Education & Training

High School/GED Name & Address

College/University Name & Address

Did you receive a degree

Yes

If yes, degree(s) received

Do you have any current professional licenses or certifications? If so please list them here.

Any other training? (graduate, technical, vocational)

Military Service

Were you in the military?

Yes

Which Branch?

Any specialized training?

References

List two non-relatives who would be willing to provide a reference for you.

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone/Mobile

Relationships

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone/Mobile

Relationship

Certification

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for the rejection of my application or, if employment commences, immediate termination.

I authorize Chey Insulation, Inc. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be “at-will.”

In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice.

Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Chey Insulation, Inc., except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

Yes, I agree

First Name

Last Name

Date