HVAC EMPLOYMENT APPLICATION
PO Box 665
Wittensville KY, 41274
606-297-6224 Phone
606-297-6225 Fax

www.BurchettsHeatandCool.com
( Please Complete Form )
Position Applying For:
Date:
Personal Information
First Name:
M.I. :
Last Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Cell Phone:
Social Security Number:
Email:
Where did you hear about us?:
Employment Information
U.S. Citizen ? :
If No explain here :
Current Employer : ( if any )
Years of Experience :
Years
KY HVAC Journeymans License :
EPA Certification :
Type 1 :
Type 2:
Type 3:
Desired Compensation : $
Available Start Date :
Education
Highest level of education completed :
Please list Name of Schools Attended :
Please list any degrees or certifications
                      earned at these Schools :
Criminal History
Have you ever been convicted of a felony or misdemeanor  :
If Yes please explain and reference any relative information:
Drivers License Information
Do you have a valid drivers license:
Drivers license number:
State of Issue:
Expiration Date:
License Type:
Do you have reliable transportation to work ( be specific ):
Military Service
Have you ever been in the armed forces? :
Branch? :
Are you a member of the national guard? :
Specialty :
Date Entered :
Discharged :
HVAC Skills ( check all that apply )
What size HVAC equipment have you worked with ( check all that apply ) :
List manufacturers ( brand ) you are familiar working with :
List type of systems you are familiar working with
                                  (i.e. Heatpump, Gas, Geothermal ) :
Which area do you have the most experience and knowledge in :
Which computer software are you experienced with :
What job functions have you performed ( select all that apply ) ? :

Work
Experience
Please list your work experience for the last (5) five years
beginning with the most recent job you held.
Name of Employer :
Address :
Phone Number :
Name of Supervisor
Employment
Dates
From
To
Reason for Leaving :
Name of Employer :
Address :
Phone Number :
Name of Supervisor
Employment
Dates
From
To
Reason for Leaving :
Name of Employer :
Address :
Phone Number :
Name of Supervisor
Employment
Dates
From
To
Reason for Leaving :
Name of Employer :
Address :
Phone Number :
Name of Supervisor
Employment
Dates
From
To
Reason for Leaving :
Name of Employer :
Address :
Phone Number :
Name of Supervisor
Employment
Dates
From
To
Reason for Leaving :
Professional References : Please list 3 - 4 people you have worked with who can attest to your on the job Experience and Performance.
Name :
Position:
Company:
Phone:
Name :
Position:
Company:
Phone:
Name :
Position:
Company:
Phone:
Name :
Position:
Company:
Phone:
ADDITIONAL INFORMATION: Use the space below to summarize any additional information necessary to                                                              describe your full qualifications for the specific position for which you are applying
Did you complete this application yourself? :
If not, who did? :
AGREEMENT ( please read carefully )
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 to 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 Burchett’s Heating and Cooling Inc. creates and actual or implied contract of employment. I understand that, if I accept
employment with Burchett’s Heating and Cooling Inc., it will be on an at will basis. This means that either Burchett’s Heating and Cooling Inc. 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 Burchett’s Heating and Cooling Inc.  I release Burchett’s Heating and Cooling Inc., and it’s employees, plus other persons or companies, from any and all liability arising out of or related in any
way to such testing.

I authorize Burchett’s Heating and Cooling Inc. to investigate information concerning my education, employment experiences and all other aspects of my background relevant to my proposed employment. I release Burchett’s Heating and Cooling Inc. and
it’s employees from all liability arising from such an investigation.
Name :
Do you accept the terms of this agreement?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Hourly
Annually
Felony
Misdemeanor
Yes
No
Operator ( most common )
Commercial  ( CDL )
Yes
No
Yes
No
1 - 5 ton
5 - 20 ton
20 - 50 ton
50 - 100 ton
Residential HVAC
Commercial HVAC
Light Commercial
Refrigeration
Windows
Mac
Office
QuickBooks
Wrightsoft
Photoshop
Other
Fabricate Metal
Install Duct
Design Duct Systems
Load Calculations
Equipment Start up
Line Voltage Wiring
Low Voltage Wiring
Braze / Solder
Refrigerant Charging
Maintenance ( Tune Up )
Service Diagnostic
Service Repair
In Home Sales
Estimating Cost
Project Management
Presentation / Demos
YES
NO
Accept