Deer Park – Spokane, WA

A-1 Rooftop Chimney Sweep Inc. EMPLOYMENT APPLICATION

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Applications are considered for all positions without regard to race, color, religion, sex, :national origin, age, marital or veteran status', or in the presence of a non-re)ated medical condition or handicap.

Date

Name:

Phone #:

Address

City

State

Zip

DOB

Are you a citizen of the United States of America?

Position applied for?

Date Available

Hours Available

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EMPLOYMENT EXPERIENCE; Start with your present job or last job. Include military assignments and other volunteer activities, Exclude organizational names which indicate race, color, religion, sex, or national origin.

Employer(1)

Address

City

State

Zip

Phone #

Supervisors Name

Job Title

Reason for leaving:

Dates of Employment (From-To)

Salary or Hourly Rate

Employer(2)

Address

City

State

Zip

Phone #

Supervisors Name

Job Title

Reason for leaving:

Dates of Employment (From-To)

Salary or Hourly Rate

Employer(3)

Address

City

State

Zip

Phone #

Supervisors Name

Job Title

Reason for leaving:

Dates of Employment (From-To)

Salary or Hourly Rate

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EMPLOYMENT APPLICATION PART 2

EDUCATION Schools/Collages Attended: # Years/ Year Grad. Degree

Describe any special qualifications for this job

Are you a veteran of the U.S. Military service?

Upload a Resume:

File Attachment

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I CERTIFY that answers given herein are true end complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or interview may result in termination. I hereby give permission to A-1 Rooftop Chimney Sweep o perform a background check and drug test upon request.

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Date

Name:

Phone #:

Address

City

State

Zip

DOB

Are you a citizen of the United States of America?

Position applied for?

Date Available

Hours Available

Free Text

Employer(1)

Address

City

State

Zip

Phone #

Supervisors Name

Job Title

Reason for leaving:

Dates of Employment (From-To)

Salary or Hourly Rate

Employer(2)

Address

City

State

Zip

Phone #

Supervisors Name

Job Title

Reason for leaving:

Dates of Employment (From-To)

Salary or Hourly Rate

Employer(3)

Address

City

State

Zip

Phone #

Supervisors Name

Job Title

Reason for leaving:

Dates of Employment (From-To)

Salary or Hourly Rate

Free Text

EMPLOYMENT APPLICATION PART 2

EDUCATION Schools/Collages Attended: # Years/ Year Grad. Degree

Describe any special qualifications for this job

Are you a veteran of the U.S. Military service?

Upload a Resume:

File Attachment

Field label

Current open positions are Chimney Sweep Technician and Office Clerk

A-1 Rooftop Chimney Sweep Inc. EMPLOYMENT APPLICATION

Deer Park Fireplace Employment Application

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