HVAC/R Employment Application Step 1 of 8 12% Position(s) Applying For:Application Date: Personal InformationName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone:Work Phone:Cell Phone:Email How did you hear about our company?Employment InformationCitizenship/Work Status U.S. Citizen Green Card Holder U.S. Work Permit/Visa Canadian Citizen Canadian Work Permit/Visa Current Employer (if any):Years of Work Experience directly related to the position you are applying for:Employment Type Desired: Full-Time Part-Time Desired Compensation: $ Hourly Annual Other Compensation Desired:When are you available to start work? EducationHigh SchoolHigh School LocationNumber of Years CompletedMajor/Degree College/UniversityCollege/University LocationNumber of Years CompletedMajor/Degree Bus. or Trade SchoolBus. or Trade School LocationNumber of Years CompletedMajor/Degree Professional SchoolProfessional School LocationNumber of Years CompletedMajor/DegreeCriminal HistoryHave you ever been convicted of a felony or misdemeanor (except any minor traffic violations)? Yes No If yes, please explain and attach any relevant documentationFileDrivers License InformationDo you have a valid driver's license? Yes No Do you have reliable transportation to work (please be specific)?Driver's License NumberState of Issue Operator Commercial (CDL) Chauffeur Do you have a clean driving record? Yes No List any Moving Violations and/or Accidents from the last 3 years:Military ServiceHave you ever been in the Armed Forces? Yes No Branch:Are you currently a member of the National Guard or Reserves? Yes No SpecialtyDate Entered Discharge Date Work ExperiencePlease list your work experience for the past 5 years beginning with your most recent job. If you were self-employed, give the firm name. Attach additional sheets if necessary. Attach Resume if applicable.Name of EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneName of last supervisorStart Pay or SalaryEnd Pay or SalaryStart Date End Date Your last job titleSpecific reason for leaving?List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.May we contact this employer? Yes No Name of EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneName of last supervisorStart Pay or SalaryEnd Pay or SalaryStart Date End Date Your last job titleSpecific reason for leaving?List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.May we contact this employer? Yes No Name of EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneName of last supervisorStart Pay or SalaryEnd Pay or SalaryStart Date End Date Your last job titleSpecific reason for leaving?List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.May we contact this employer? Yes No Name of EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneName of last supervisorStart Pay or SalaryEnd Pay or SalaryStart Date End Date Your last job titleSpecific reason for leaving?List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.May we contact this employer? Yes No HVAC/R Industry SkillsHVAC/R Industry Skill Section Instructions: ONLY select the specific industry skills that you consider yourself to be very knowledgeable about, with a high level of competency. What size of HVAC/R equipment have you worked with? (Select all that apply) 1 - 5 Tons 5 - 20 Tons 20 - 50 Tons 50 - 100 Tons 100+ Tons What Manufacturers Equipment have you worked with? (Select all that apply) American Standard Andover Controls Beverage Air Bryant Carrier Coleman Cornecius Crystal Tip Cummins & Woodward Daikin DelField Electro Freeze Frigidaire Gibson Honeywell Hoshizaki Ice O Matic ICEE Johnson Controls Kelvinator Kold Draft Lennox Liebert Luxaire Manitowoc Maytag McQuay Perlick Philco Rheem Ruud Sani Serv Seibe Siemens Storlting Tappan Taylor Tekmar Thermo King Toshiba Trane Traulsen TRUE United Victory Vogt Westinghouse York What types of Equipment or Systems have you worked with? (Select all that apply) 410A Absorption Systems Air Dist. Equipment Air Handlers Ammonia Anti-Vibrations Appliances Appliances - Home Bobtail Units Boilers Cascade Refrigeration Central Plants Centrifugal Chilled Water Chillers Cold-Plate Systems Commercial Cooking Equip Cooling Towers Dehumidification Dish Washers Dry Systems Dry-Coolers Dryers - Clothes Electric Stoves Environmental Test Chambers Exhaust Systems FCB Machines Forced Air Systems Freezers - Commercial Frozen Beverage Machines Furnace Gas Gas Stoves Geo Thermal Ground Source Heat Pumps Heat Pumps Humidification HVAC Equipment Hydronic Ice Cream Machines Ice Machines In-Floor Oil Ovens - Electric Ovens - Gas Package Units Parallel Refrigeration Portable HVAC Propane Puron Radiant Heating Reach-Ins Recipricating Refrigeration Refrigerators Rooftop Units Split Systems Steam Trailer Units Transport Refrigeration Variable Speed Equipment VAV Ventilation VRF VRV Walk-Ins Washers - Clothes Water Heaters Wet Systems Window Units AC HVAC/R Industry Skills ContinuedWhat types of Parts and Accessories have you worked with? (Select all that apply) Coils Compressors Condensers Dampers Diffusers Duct Work Electric Motors Fans Grills HVAC Parts Registers Sheet Metal Sound Attenuators Vacuum Pumps Valves What Applications do you have experience with? (Select all that apply) Clean Rooms Cold Storage Commercial Floating Floor Government Projects Grocery Stores Hospitals Industrial Institutional International Light Commercial Marine Multi-Family Off-Shore Pools Residential Restaurants Snow Melting What types of Building Automation or controls experience do you have? Building Automation Controls Controls - Design Controls - Programming DDC Pneumatic controls What Job Functions have you performed? (Select all that apply) Activity Reporting Advertising (broadcast) Advertising (online) Advertising (print) Assembling Brazing Budgeting Business Development Call Center Management Carpentry Change Orders Channel Development Client Interaction Client/Account Management Cold Calling Commission Development Computer Literate Consultative Selling Contract Negotiations Contract/Proposal Preparation Conventions/Trade Shows Customer Service Data Entry Department Forecasting Design/Build Designer Develop Relationships/Alliances Dispatcher Drafting Draftsman Driving Drywall Repair Electrical Energy Energy Management Engineer/BSME Engineer/PE Estimating Estimator Executive Expense Reports Fabrication Facility Manager Field Supervisor Forecasting Foreman General Construction General Manager Goal Setting Heat Transfer Inspector Installation Installation - New Homes Installer Instructor International Journeyman Lead Generation Lead Management Leadership LEED Load Calculations Machine Operator Maintenance Maintenance - Apartment Manager Manufacturer Rep Manufacturing Market Analysis Material Handler NATE Certification NEBB Negotiate Contracts Operations Manager P&L Pipefitter Piping Plan-O-Grams/Schematics Plan/Spec Planning PLC Plumbing Policy/Procedure Development Prepare Financial Reports Presentation Preparation Preventative Maintenance Product Demonstration Product Design Product Development Product Testing Production Production Specialist Project Management Project Scheduling Proposal Development Proposal Presentation Prospecting/Lead Generation Punch List Purchase Orders Purchasing QA/QC Manager Quality Assurance/Control Reading Blueprints Relationship Management Repair Report Generation Reporting Research Retro-Fit Sales Sales - In Home Sales - Residential Sales - Retail Sales - Wholesale Sales Management, Area Sales Management, National Sales Management, Regional Sales Manager Sales Training Development Service Service Agreements Service Manager Sheet Metal Worker Shipping Coordination Shipping/Receiving Start-up Steamfitter Strategic Alliances Superintendent Supervision Take-offs Team Building Technician Telemarketing - Inbound Telemarketing - Outbound Territory Management Test & Balance Thermodynamics Trainer Troubleshooting Vendor Coordination Welder Welding What Computer related experience do you have? (Select all that apply) ACT Approach AutoCad Derby Ecco Pro Echelon Energy Pro Estimation (software) Goldmine Load/Trace 700 Lon Works Lon-Based Cicron Manual J Microstation MS Access MS Excel MS Office MS PowerPoint MS Word QuickPen SalesLogix Seibe Trane Duct/Pipe Designer WinSales Wrightsoft Certifications & LicensesWhat Certifications & Licenses do you have? (Select all that apply) (CAMT) Certified Apartment Maint Technician Certified Energy Manager EPA 608 Type I EPA 608 Type II EPA 608 Type III EPA 608 Universal HVAC Excellence - A/C HVAC Excellence - Commercial A/C HVAC Excellence - Commercial Refrigeration HVAC Excellence - Electrical Heat HVAC Excellence - Gas Heat HVAC Excellence - Geothermal HVAC Excellence - Heat Pumps HVAC Excellence - Hydronics I HVAC Excellence - Hydronics II HVAC Excellence - Oil Heat ICE - Commercial Refrigeration ICE - Light Commercial A/C & Heating ICE - Residential A/C & Heating Journeyman HVAC License Journeyman Plumber License Master HVAC License Master Plumber License NATE - A/C NATE - Air Distribution NATE - Gas Heat NATE - Heat Pumps NATE - Oil Heating Oil Burner License Registered Professional Engineer Include State and License Numbers for any licenses selected above, if applicable:Other Licenses & Certifications held:Additional InformationUse the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. If you have a resume, please include it with this application.Professional ReferencesPlease list 1-2 people you have worked with who can attest to your On-the-Job experience and performance.Name First Last PositionCompanyPhoneEmail Name First Last PositionCompanyPhoneEmail Did you complete this application yourself? Yes No If not, who did?AGREEMENT (PLEASE READ CAREFULLY BEFORE SIGNING)I certify that all the information on this application is accurate and complete to the best of my knowledge and understand that misleading or false statements will constitute sufficient cause for refusal of hire or termination of my employment. I understand that neither the acceptance of this application nor the subsequent entry into any type of employment relationship with Ultimate Heating & Air creates an actual or implied contract of employment. I understand that, if I accept employment with Ultimate Heating & Air, it will be on an at-will basis. This means that either Ultimate Heating & Air or I have the right to terminate the employment relationship at any time, for any reason, with or without cause. I agree to submit to drug and alcohol testing, if requested by Ultimate Heating & Air. I release Ultimate Heating & Air, and its employees, plus other persons or companies, from any and all liability arising out of or related in any way to such testing. I authorize Ultimate Heating & Air to investigate information concerning my education, licensing,certifications, driving record, criminal history, employment experiences and all other aspects of my background relevant to my proposed employment. I release Ultimate Heating & Air and its employees from all liability arising from such investigation.Name of Applicant First Last Date Ultimate Heating & Air is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with Ultimate Heating & Air depends solely on your qualifications.