Employment Application

Christianson Application for Employment

Equal Opportunity Employer

Step 1 of 8 - Page1

Personal lnformation
Legal Name*
First Middle Last
Social Security Number*
Nickname
Present Address*
Street Address Address Line 2 City State ZIP Code
Primary Phone*
Alternate Phone
Email
How did you learn of this opening?
List relatives/friends who work for CHRISTIANSON
Have you ever applied to, or been employed by CHRISTIANSON Air Conditioning & Plumbing? If yes, give date of application/employment.
Can you perform the essential functions of this Job with or without reasonable accommodation?*

YES

NO
If accommodation were needed, what would that be?*
Are you 18 years of age or older?*

Yes

No
If hired, can you submit certification of your legal right to work In the U.S.?*

Yes

No

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Employment Desired

Position Desired*

Date Available to Start*
MM slash DD slash YYYY

Salary Desired

Type of Employment*
Full-time
Part-time
Summer
Felony/Misdemeanor Convictions

NOTE: A criminal conviction, deferred prosecution/adjudication, probation, court supervision, found or plead guilty to a criminal charge, or pending charge will not necessarily disqualify an applicant from employment. The date of conviction, nature of crime and other relevant factors will be considered in making the employment decision.
Have you ever been convicted, received deferred prosecution/adjudication, probation, court supervision, or found/plead guilty to a criminal charge (felony or mlsdemeanor)?*

YES

NO
If yes, state nature of the crime(s), location/jurisdiction, and disposition of the case.*

Driver's License
The following section must be completed If you are applying for a position that requires the operation of a motor vehicle, owned or leased by the company, or if you must use your own vehicle for company purposes. If assigned a company vehicle, you will be subject to periodic Driver License Record checks.
Driver's License Number:

State Issued
Expiration Date
MM slash DD slash YYYY

Has your driver's license ever been suspended or revoked for any reason?*

YES

NO
If yes, Please give date and reason:*

Have you been involved in a vehicle accident of any type within the last 5 years?

YES

NO
If yes, give date(s), the nature and severity of the accident(s).*

If you have been convicted of driving while intoxicated or under the influence, please explain:

List traffic citations you have received during the last 5 years preceding date of this application, and state the disposition of each, such as "dismissed", "paid fine", "defensive driving", etc.
DATE
MM slash DD slash YYYY

TYPE

DISPOSITION

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Education
Grammar School

Name and Location

High School

Name and Location

Years Attended

Certification Received
College
Name and Location

Course / Major

Years Attended

Certification/Degree Received

Technical/ Business School
Name and Location

Course / Major

Years Attended

Certification Received

Professional Credentials or Certifications
Name and Location

Certification Received

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Skills
HVAC/Plumblng Skills

Laborer

Apprentice

Journeyman

Foreman

Superintendent
List any other skills you have that are relevant to the Job for which you are applying:
Professional license Held:

State

Number

Date Expires
MM slash DD slash YYYY

Employment History

This section must be completed: List below all present and past employment starting with your most recent employer (last ten years). Account for all periods of unemployment. You must complete this section even if attaching resume. Attach an additional sheet If necessary.
ARE YOU CURRENTLY EMPLOYED?*

YES

NO
Current or Most Recent Employer
Company

Job Title/Position

Salary

Address

Supervisor

Phone

Dates of Employment
From (month/year)

To (month/year)

Description of Duties (Indicate responsibilities, accomplishments and contributions)

May we contact this employer?

YES

NO
Reason For Leaving
Previous Employer
Company

Job Title/Position

Salary

Address

Supervisor

Phone

Dates of Employment
From (month/year)

To (month/year)

Description of Duties (Indicate responsibilities, accomplishments and contributions)

Reason For Leaving
Previous Employer
Company

Job Title/Position

Salary

Address

Supervisor

Phone

Dates of Employment
From (month/year)

To (month/year)

Description of Duties (Indicate responsibilities, accomplishments and contributions)

Reason For Leaving
Previous Employer
Company

Job Title/Position

Salary

Address

Supervisor

Phone

Dates of Employment
From (month/year)

To (month/year)

Description of Duties (Indicate responsibilities, accomplishments and contributions)

Reason For Leaving
Please explain all periods of unemployment:

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Military Service Record
Are you a U.S. Veteran?

YES

NO
If YES, please provide dates of service

List any training you received In the U.S. Armed Forces that Is relevant to the position you are applying for:

Emergency Contact
In Case of Emergency Notify:
Name*

Phone*

Professional References
Reference 1
Name

Company

Business Relationship

Phone

Years Known

Reference 2
Name

Company

Business Relationship

Phone

Years Known

Reference 3
Name

Company

Business Relationship

Phone

Years Known

CHRISTIANSON Air Conditioning & Plumbing IS PROUD TO OFFER A DRUG-FREE WORKPLACE. ALL APPLICANTS ARE REQUIRED TO SUBMIT TO A PRE-EMPLOYMENT DRUG SCREEN.
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment. I also understand that an incomplete or unsigned application will not be considered. I authorize investigation of statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you. I understand that, if hired, the employer follows an "employment at will" policy in that I or the employer may terminate my employment at any time with or without cause. This ''employment at will" policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the President of CHRISTIANSON Air Conditioning & Plumbing. I understand that federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity. Failure to submit such proof will result in denial of employment.
Slgnature*

Date*
MM slash DD slash YYYY

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Applicant Notification / Release of Information
Fair Credit Reporting Act Disclosure
CHRISTIANSON, Air Conditioning & Plumbing

when considering your application for employment

when making a decision whether to offer you employment

when deciding whether to continue your employment (if you are hired); and

when making other employment related decisions directly affecting you.
may wish to obtain and use a "consumer report" from a "consumer reporting agency." These terms are defined in the Fair Credit Reporting Act (FCRA), which applies to you. As an applicant for employment or employee of Christianson, you are a "consumer" with rights under the FCRA.

I.   A "consumer reporting agency" is a person or business that, for monetary fees, dues, or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on consumers for the purpose of furnishing "consumer reports" to others, such as Christianson.

II.   A "consumer report" is a written, oral, other communication of any information by a "consumer reporting agency" bearing on a consumer's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living which is used or collected for the purpose of serving as a factor in establishing the consumer's eligibility for employment purposes.

III.   If Christianson obtains a "consumer report" about you, and if Christianson considers any information in the "consumer report" when making employment related decision that directly and adversely affect you, you will be provided with a copy of the "Consumer report" before the decision is finalized. You also may contact the Federal Trade commission about your rights under the FCRA as "consumer" with regard to "consumer reports" and "consumer reporting Agencies."
The purpose of this form is to notify you that a Consumer Report and/or an Investigative Consumer Report will be conducted on you in the course of consideration for employment. I hereby authorize your company or any agent of Christianson to contact any and all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county, and federal courts and military services to release information about my back ground including, but not limited to, information about my employment, education, consumer credit history, driving record, criminal record, and general public records history to the person or company with which this form has been filed. This releases the aforesaid parties from any liability and responsibility for collecting the above information. This release shall remain in effect for the length of my employment. I understand I have the right to obtain a free copy of this consumer report if; (1) Any adverse action/decision is made based on the information in the consumer report, & (2) If the request is made in writing within 60 days of the adverse action. If an Investigative Consumer Report is conducted, I will be notified in writing within three days from request of said report. I believe to the best of my knowledge that all information I have provided is accurate, true, and correct and that I fully understand the terms of this release.

The following is my true and complete legal name and all information is true and correct to the best of my knowledge.
Signature*

Date*
MM slash DD slash YYYY

Last Name*

First Name*

Middle Name

List any other name used in the last 7 years:

Date of Birth (for ID purposes only):*
MM slash DD slash YYYY

Social Security Number*

Drivers License #

State

Expiration Date

Professional License Held

State

License #

Current Address*

City*

State*

Zip*

Date: Month/Year

To: Month/Year

List other cities or towns you have lived in the past 7 years. Use additional pages if necessary
City

State

Zip

Dates: Month/Year

To: Month/Year

City

State

Zip

Dates: Month/Year

To: Month/Year

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DRUG TEST REQUIREMENT FORM
In consideration for my employment by CHRISTIANSON Air Conditioning and Plumbing, I agree to submit to a drug test prior to my employment.

I acknowledge that if I am hired before the results of the test are received, and it subsequently is determined to be positive, my employment by CHRISTIANSON Air Conditioning and Plumbing will be terminated for just cause.

I acknowledge that if the drug test results are received prior to my start date, and it is determined to be positive, this offer of employment will be withdrawn.

I further acknowledge that I will not be considered for submitting an application for rehire until a minimum of three months have passed, if the test results are positive.

Signature of Applicant*

Date*
MM slash DD slash YYYY

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DPS Computerized Criminal History (CCH) Verification
I (Insert Your Name),*

acknowledge that a Computerized Criminal

History (CCH) check may be performed by accessing the Texas Department of Public Safety Secure Website and may be based on name and DOB identifiers. (This is not a consent form, but serves as information for the applicant.) Authority for this agency to access an individual’s criminal history data may be found in Texas Government Code 411; Subchapter F.

Name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history record information (CHRI), therefore the organization conducting the criminal history check is not allowed to discuss with me any CHRI obtained using the name and DOB method. The agency may request that I also have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search.

In order to complete the fingerprint process I must make an appointment with the Fingerprint Applicant Services of Texas (FAST) as instructed online at www.dps.texas.gov /Crime Records Information/Review of Personal Criminal History or by calling the DPS Program Vendor at 1-888-467-2080, submit a full and complete set of fingerprints, request a copy be sent to the agency listed below, and pay a fee of $25.00 to the fingerprinting services company.

Once this process is completed the information on my fingerprint criminal history record may be discussed with me.

(This copy must remain on file by this agency. Required for future DPS Audits)

Please: Check and Initial each Applicable Space

CCH Report Printed:

YES _____ NO ______ ________ initial

Purpose of CCH:

Empl ____ Vol/Contractor ____ ________ initial

Date Printed: _______________ ________ initial

Destroyed Date: _____________ ________ initial

Retain in Your Files

Rev. 06/2021
Signature of Applicant or Employee*

Signature of Applicant or Employee
MM/DD/YYYY*
MM slash DD slash YYYY

Date
UPLOAD RESUME
You may upload your resume with the employment application.
Accepted file types: pdf, doc, docx, Max. file size: 5 MB.

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Christianson Application for Employment

Step 1 of 8 - Page1

Personal lnformation

Employment Desired

Felony/Misdemeanor Convictions

Driver's License

Education

Grammar School

High School

College

Technical/ Business School

Professional Credentials or Certifications

Skills

Employment History

Current or Most Recent Employer

Dates of Employment

Previous Employer

Dates of Employment

Previous Employer

Dates of Employment

Previous Employer

Dates of Employment

Military Service Record

Emergency Contact

Professional References

Reference 1

Reference 2

Reference 3

Applicant Notification / Release of Information

Fair Credit Reporting Act Disclosure

DRUG TEST REQUIREMENT FORM

DPS Computerized Criminal History (CCH) Verification

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