Employment Application - Daffan Cooling & Heating

Employment History
Please provide the following information on your most recent 3 employers. (NOTE: List employers in reverse order starting with the most recent.)
Employment History*
Phone #*
Address*
City*
State*
Zip*
Job Title*
Start Date*
Date Format: MM slash DD slash YYYY
End Date*
Date Format: MM slash DD slash YYYY
Job Title*
Start Pay*
End Pay*
Work Duties*
Reason for Leaving*
Employment History*
Phone #*
Address*
City*
State*
Zip*
Job Title*
Start Date*
Date Format: MM slash DD slash YYYY
End Date*
Date Format: MM slash DD slash YYYY
Job Title*
Start Pay*
End Pay*
Work Duties*
Reason for Leaving*
Employment History*
Phone #*
Address*
City*
State*
Zip*
Job Title*
Start Date*
Date Format: MM slash DD slash YYYY
End Date*
Date Format: MM slash DD slash YYYY
Job Title*
Start Pay*
End Pay*
Work Duties*
Reason for Leaving*

This certifies that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge. I authorized you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary for arriving at an employment decision. I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. 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 Company, as permitted by law.
Signature*
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APPLICATION FOR EMPLOYMENT