Employment Application Form

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Employment Application

APPLICANT INFORMATION
Name
First Last
Phone*
Date
Date Format: MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Date Available
Desired Salary
Position Applied For
Have you ever worked for this company?
- Yes
- No
Have you ever been convicted of a felony?
- Yes
- No
If yes, please explain:
EDUCATION
High School
Dates Attended
Did You Graduate?
- Yes
- No
College
Dates Attended
Did You Graduate?
- Yes
- No
Degree
Other
Dates Attended
Did You Graduate?
- Yes
- No
Degree
REFERENCES
Please list three professional references
Full Name
Relationship
Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Full Name
Company
Relationship
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Full Name
Company
Relationship
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
PREVIOUS EMPLOYMENT
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
Dates Worked (From - To)
Reason for Leaving
May we contact your previous supervisor for a reference?
- Yes
- No
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
Dates Worked (From - To)
Reason for Leaving
May we contact your previous supervisor for a reference?
- Yes
- No
Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
Dates Worked (From - To)
Reason for Leaving
May we contact your previous supervisor for a reference?
- Yes
- No
MILITARY SERVICE
Branch
Dates (From - To)
Rank at Discharge
Type of Discharge
If other than honorable, please explain:
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature
Date
Date Format: MM slash DD slash YYYY

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Certifications/Associations

Manufacturers

Testimonials

My husband and I purchased a 1910 Queen Anne Victorian home in the Heights which was more than just a small weekend project! One of the restoration tasks included completely gutting the old fireplace, chase, and chimney as they were not to code or functioning properly. Lords Chimney worked many hours on our "little" project removing the old brick (a very dirty job!) and retrofitting an entirely new system, even taking care to match the chimney brackets to the original brick color. The original brick was saved and placed in a nice pile for us in the back yard so that we could use it to lay a patio. We are so thrilled with our new fireplace and lovely gas logs. We look forward to hiring Lords Chimney to tackle a second fireplace upstairs. A big thank you to Lords for a terrific job!
~ Amanda S.