Robert B. Payne, Inc. Estimate Request - Heating - Air Conditioning - Fuel Oil

Employment Application

EMPLOYMENT
APPLICATION

Equal Opportunity Employer
This application is subject to review by

ROBERT B. PAYNE, INC.

We are a DRUGFREE WORK PLACE.

We consider applicants for all postions without regard to race, color, religion, creed, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
POSITION APPLIED FOR
Position:
Date Available to Work:
Date of Application:


GENERAL INSTRUCTIONS
HOW DO WE CONTACT YOU
Where to find vacancy information?
  • The Free Lance-Star Classifieds
  • Call Human Resources 540/373-5876
  • www.robertbpayne.com
    		•
     
  • All information you submit is subject to verification.
    		•
    How did you learn about us?
    Others:
    Name:
    Social Security No:
    Your Mailing Address:
    City
    State
    Zipcode
    Email
    Home Phone
    Mobile Phone
       


    EDUCATION

    HIGH SCHOOL
    Name/Address of School:
    Recieved:
    Your Name, if different while attending school:
       

    COLLEGE, UNIVERSITY OR PROFESSIONAL SCHOOL: (TRANSCRIPTS MAY BE REQUIRED)
    Name of School
    Location
    Dates Of Attendance (Years)
    Major/Minor course of Study
    Type of Degree earned
       
    From
    To
    		   
    Your Name, if different while attending school:
     

    JOB RELATED TRAINING OR COURSE WORK: (VOCATIONAL, TRADE, GOVERNMENTAL, BUSINESS, ARMED FORCES, ETC.)
    Name of School
    Location
    Dates Of Attendance (Years)
    Course of Study
    Training Completed earned
       
    From
    To
    		   
    Yes No
    Yes No
    Your Name, if different while attending school:
     

    LICENSURE, REGISTRATION, CERTIFICATION EXAMPLES: Driver License, Certificates related to HVAC, Electrical, Plumbing, Etc.
    License, Registration or Certificate:
    Number
    Exp. Date
    Valid Currently?
    State Licensing Agency
    Yes No
    Yes No
    If you are a licensed driver, have you had any traffic violations in the last five (5) years? Yes No
    If yes, please describe:
     
     


    CURRENT EMPLOYMENT / AVAILABILITY
    Are you currently employed?
    If yes, may we contact your present employer?
    Which of the following are you available to work:
    		 Full Part Time Shift Temporary
    Are you currently on a "Lay Off" status and subject to recall?
       
    PERIODS OF EMPLOYMENT
     
    Describe your work experience in detail, beginning with your current or most recent job. Use a separate block to describe each position. Include military service (indicate rank) and job-related volunteer work, if applicable. Indicate number of employees supervised. Provide an explanation of any gaps in employment. Resumes are acceptable for the description of duties and responsibilities only. All other information in this section must be completed.
       
    Name of Present or Last Employer:
    Address:
    Phone No.:
    Your Job Title:
    Supervisor's Name:
    From:
    To:
    Hours per week:
    Your Name, if different during employment:
    Duties and Responsibilities:
    What is / was your wage?
    Reason for Leaving:
    		 
    Name of Next Previous Employer:
    Address:
    Phone No.:
    Your Job Title:
    Supervisor's Name:
    From:
    To:
    Hours per week:
    Your Name, if different during employment:
    Duties and Responsibilities:
    What is / was your wage?
    Reason for Leaving:
    		 
    Name of Next Previous Employer:
    Address:
    Phone No.:
    Your Job Title:
    Supervisor's Name:
    From:
    To:
    Hours per week:
    Your Name, if different during employment:
    Duties and Responsibilities:
    What is / was your wage?
    Reason for Leaving:
       
    PERSONAL AND/OR PROFESSIONAL REFERENCES
    Please list at least 3 each references in the spaces provided below:
       
    Name
    Relationship
    Telephone
    Known How Long?
       
    SKILLS
    List skills you possess and believe relevant to the position you seek, such as operating heavy equipment, computer skills, other technical or mechanical skills, etc.
       
       
    SPECIALIZED SKILLS for Office Positions
    Check Skills / Equipment Operated
       
    Personal Computer Microsoft Office (Word, Excel, Outlook, etc)
    Others
       
    SPECIALIZED SKILLS for Jobsite or Workshop Positions
    Check Skills / Equipment Operated
       
    Others
       
    ADDITIONAL VOLUNTARY INFORMATION
    State any additional information you feel may be helpful to us in considering your application:
       
       


    BACKGROUND INFORMATION
    HAVE YOU EVER BEEN CONVICTED OF A FELONY OR A FIRST DEGREE MISDEMEANOR?
    		 Yes No
    If "YES", what charges?
    Where convicted?
    Date of Conviction
    HAVE YOU EVER PLED NOLO CONTENDERE OR PLED GUILTY TO A CRIME WHICH IS A FELONY OR A
    FIRST DEGREE MISDEMEANOR
    		 Yes No
    If "YES", what charges?
    Where?
    Date
    NOTE: A "YES" answer to these questions will not automatically bar you from employment. The nature, job, relatedness, severity and date of the offense in relation to the
    position for which you are applying are considered.
     
    CITIZENSHIP
     
    ARE YOU A U.S. CITIZEN OR ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?
    		 Yes No
    NOTE: Our company hires only U.S. citizens and lawfully authorized alien workers. If a conditional offer of employment is made, you will be required to provide proof of
    citizenship or authorization to work in the U.S.
    RELATIVES
     
    TO YOUR KNOWLEDGE, DO YOU HAVE ANY RELATIVES WORKING WITH OUR COMPANY?
    		 Yes No
    PREVIOUS APPLICATION OR EMPLOYMENT
     
    HAVE YOU EVER FILED AN APPLCATION WITH US BEFORE?
    		 Yes No
    IF YES, GIVE DATE:
    HAVE YOU EVER BEEN EMPLOYED WITH US BEFORE?
    		 Yes No
    IF YES, GIVE DATE:
    UNDERAGE ELIGIBILITY
     
    ARE YOU UNDER 18 YEARS OF AGE?
    		 Yes No
    IF YES, CAN YOU PROVIDE PROOF OF ELIGIBILITY TO WORK?
    		 Yes No
     
    APPLICANT'S STATEMENT
     
    I certify that answers given herein are true and complete to the best of my knowledge.

    I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

    This application for employment shall be considered active for a period of time not to exceed 6 months. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

    I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

    In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
       
    To accept the above statement, type in your name here:
    Date:
     
    Consumer Report Notification
     

    You are hereby notified that a consumer report or an investigative consumer report may be obtained from a consumer reporting agency, or directly by this employer for the purpose of evaluating you for employment, promotion, retention, or reassignment as an employee.

    The report may contain information bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living from public or private record sources or through personal interviews with your neighbors, friends, associates or educational facility.
     
    Release Form For Consumer Reports
     

    I, , understand that consumer reports or investigative consumer reports which may contain public record information may be requested or made on me including consumer credit, criminal records, driving record, education, prior employer verification, workers compensation claims and others. These reports will include experience along with reasons for termination of past employment. Further I understand that you may request information from various Federal, State, local and other agencies which contain my past activities.

    In connection with this application for employment and any future promotions or reassignments, I hereby authorize without reservation, any party or agency contacted by ROBERT B. PAYNE, INC. to furnish the above mentioned information.

    I further authorize ongoing procurement of the above mentioned reports at any time during my employment (or contract).

    I have the right to make a request for information in files on me pending proper identification and the payment of any authorized fees.

    I have read this document and understand it. Furthermore, I understand that I have the right to dispute inaccurate information with the Consumer Reporting Agency which has provided the disputable data. (The CRA must investigate the item--usually within 30 days--by presenting to its information source all relevant evidence submitted by me.) I understand that the CRA must give me a written report of the investigation, and a copy of my report if the investigation results in any change. If the CRA's investigation does not resolve the dispute, I have the right to add a brief statement to my file which must be included at least in summary in future reports. I also have the right to ask that anyone who has recently received my report be notified of the change.
     
    Name:
    Street Address:
    City
    State
    Zipcode
    Social Security No:
    Drivers License
    		  
    State:
    License Number:
    Date of Birth:
    Other or Former Names:
    To accept the above, type in your name here:
    Date:
       
       

    Attention all job applicants:

    During your personal interview you will be required to provide a certified copy of your motor vehicle report and a photocopy of your drivers license.

     

    Customer Testimonials:
     
    1209 Lafayette Blvd., PO Box 480, Fredericksburg, VA 22404
    Phone: 540-373-5876   Fax: 540-899-0544   Toll Free: 1-877-RBPAYNE
    © 2008 Copyright  Robert B. Payne, Inc. All Rights Reserved. Privacy Notice